Pericardial Diseases

Acute Pericarditis: 

  • Idiopathic, MCC: infectious (viral; coxsackie B), inflammatory (SLE, RA), metabolic (uremia), recent MI (acute or Dresseler’s syndrome)
  • Sx: positional pleuritic chest pain, relieved by sitting up and leaning forward, worsened by laying down and breathing
  • PE: pericardial friction rub
  • ECG: diffused PR depression + diffused ST elevation
  • Do Echo to determine extent of effusion
  • Tx: Aspirin + NSAIDs ± steroids

 


Pericardial Effusion: 

  • Not a diagnosis, but a manifestation of an underlying cause
  • Can be:
    • Transudate: fluid overload, CHF, hypoalbuminemia
    • Exudate: chest injury\trauma
    • Serosanguineous: TB, neoplasm
    • Frank blood: ruptured aortic aneurysm \ coronary, LV free wall bleed post-MI, penetrating trauma
  • PE: muffled HS, pericardial friction rub, JVD (if severe, hypotension, LOC), Ewart’s sign
  • ECG: low QRS voltage, flat T waves, electrical alternans
  • CXR: “water-bottle” configuration of the cardiac silhouette
  • Dx: Echo
  • Tx: fluid aspiration + tx underlying cause

 


Cardiac Temponade: 

  • EMERGENCY! rapid filling of fluid into pericardial sac
  • Anything that causes pericarditis -> can cause tamponade
  • Sx: pressure surrounding the heart -> can’t pump -> left sided HF (SOB, orthopnea, cough), LOC
  • PE: pulsus paradoxus, Kussmaul’s sign, tachcardia
  • Beck’s triad: muffled heart sounds, hypotension, JVD
  • ECG: low QRS voltage, electrical alternans
  • Dx: Echo
  • Tx: pericardiocentesis

 


Constrictive Pericarditis: 

  • Chronic inflammation, either due to multiple acute pericarditis attacks or post open-heart surgery
  • Sx: constrictive = heart can’t expand and pump -> both Lt + Rt sided HF (SOB, orthopnea, cough, peripheral edema, ascites, hepatosplenomegaly)
  • PE: pericardial knock sound, distant HS, Kussmaul’s sign, Friedreich’s sign (prominent “y” descent)
  • Dx: echo -> cardiac MRI for definitive dx
  • Tx: diuretics, salt restriction -> pericardiectomy

 

Pericardial diseases 5

 


Download the PDF version: here


References:

  • Dr Alghamdi’s lectures
  • Kaplan lecture notes
  • Toronto notes
  • Paul Bolin’s videos
  • Lifeinthefastlane.com

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