Pericarditis

2. A) Acute pericarditis B) pericardial effusion C) Tamponad D) constrictive pericarditis

3. A)Acute pericarditis Definition: inflammation in visceral & parietal pericard

4. A)Acute pericarditis • Ethioligy: usually is idiopathic The most cause in not idiopathic causes is viral infections other (Tb, hypothyroidism, uremia, radiation, autoimmune dis. ,cancers ,after MI( Dressler's syn),drugs( hydralazine , isoniazid , procaine amid)

5. A)Acute pericarditis • Clinical findings: • Pruritic chest pain +/- Friction rub • ECG change :ST elevation in all leads (except V1&aVR) for 1week then T invertion

7. After 2 weeks:

8. A)Acute pericarditis • DDX: MI pulmunay emboli

9. A) Acute pericarditis *Diagnosis: clinic & ECG changes *Lab data: -ESR , CRP , WBC -PPD(TB) -BUN , Cr(urinary sys) -TFT(thyroid) -RF , ANA -HIV -CK-MB & Troponin -CXR & ECHO

10. A)Acute pericarditis • Treatment : 1.base: NSAID 2. Colchicine 3.CORTON *Anti coagulant((ممنوع

11. A)Acute pericarditis • :عوارض -Recurrence -Pericardial effusion -Constrictive pericarditis -Tamponad

12. b)Pericardial effusion: • Definition: • Abnl fluidstorage in pericardial space • Ethiology: causes of pericarditis chylopericardium & hemopericardium

13. b)Pericardial effusion: • Clinical findings: it is related to speed & volume of fluid storage 1)slow (much) 2)fast (little)

14. b)Pericardial effusion: • P/E & paraclinc: • 1.ECG • 2. • 3.ECHO • 4.CT &MRI • 5.Pricardiosintesis • 6. excisional biopsy

16. b)Pericardial effusion: • 2.CXR • 3.ECHO • 4.CT &MRI • 5.Pricardiosintesis • 6. excisional biopsy

17. b)Pericardial effusion: • Treatment : • 1.unstable Pt. • 2.pt. with recurrent pericardial effusion • 3.in asymptomatic pericardial effusion

18. c) tamponade : 1.Definition: compression of the heart by an accumulation of fluid in the pericardial sac. This pressure is on of the whole heart. 2. pathogenesis

19. c) tamponade : -Clinical manifestation: 1:when slowly accrue 2.When fast accrue -P/E:triad:1.hypotension 2.JVP bulging 3.muffle heart sounds Tachypnea,pulsusparaduxicus ,clear lung , silent heart,

20. c) tamponade : Dx: 1.ECG

21. c) tamponade : Dx: 2.CXR 3.ECHO:GOLD standard 4.RV catheterisation

22. c) tamponade : Dx: 4.RV catheterisation

23. c) tamponade : Treatment: heart tamponade is the emergency in medicine and need fast treatment 1.Iv therapy 2.Vasopressor drugs 3.درمان قطعی : pericardiocentesis

24. c) Constrictive pericarditis(CP) : تعریف:پریکاردیت فشارنده که در نتیجه ی اسکار دایمی پریکارد ثانویه به بیماری های التهابی بوجود آمده و با پریکارد ضخیم و فیبروتیک(یا کلسیفیه)که پر شدن دیاستولیک قلب را محدود می نماید ،مشخص می شود فیزیوپاتولوژی-

25. c) Constrictive pericarditis(CP) : Etiology: usually idiopatic other causes: viral inf. radiation connective tissue dis.

26. c) Constrictive pericarditis(CP) : Clinical manifestations: Common presentations are Rt. Sided Heart failure :dyspnea fatigue abd.pain liver congestion ascites leg edema

27. c) Constrictive pericarditis(CP) : P/E: -JVP bulging(with kussmaul sign is +) -Diastolic pressure in atrium= Diastolic pressure in ventricle -Usually pulsusparadoxusnot seen in CP -Pericardial Knock -/+

28. c) Constrictive pericarditis(CP) : Para clinic: 1.CXR 2.ECHO

29. c) Constrictive pericarditis(CP) : Para clinic: 2.ECHO

30. c) Constrictive pericarditis(CP) : Para clinic: 3.CT & MRI 4.RV catheterisationتشخیص قطعی 5.Bx:for ddx

31. c) Constrictive pericarditis(CP) : Treatment: 1.Salt free foods + diuretics 2.Surgery and pericardiotomy