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Pericardial Diseases

Pericardial Diseases. Acute Pericarditis. Etiology Acute, Subacute , Chronic Infectious, Non-infectious, Hypersensitivity/autoimmunity. History & Physical Examination:. Chest pain Fever Palpitation Pericardial friction rub Rapid or irregular pulse. Laboratory:. ECG:

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Pericardial Diseases

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  1. Pericardial Diseases

  2. Acute Pericarditis • Etiology • Acute, Subacute, Chronic • Infectious, Non-infectious, Hypersensitivity/autoimmunity

  3. History & Physical Examination: • Chest pain • Fever • Palpitation • Pericardial friction rub • Rapid or irregular pulse

  4. Laboratory: • ECG: • Diffuse ST elevation, • PR depression, • APC, • AF. • Remember to differentiate with ERV.

  5. Chest X-ray: • Water bottle sign if pericardial effusion develops. • Echocardiography: • Not for pericarditis but the most readily available test for pericardial effusion.

  6. Treatment: • Aspirin 650 – 970 mg / qidor other NSAIDs. • Addition of cholchicine may be useful. • For severe, refractory pain, prednisolone. • For intractable, prolonged pain or recurrent episodes, pericardiectomy.

  7. Cardiac Tamponade • Life-threatening condition. • Impaired filling of cardiac chambers.

  8. Etiology: • Idiopathic or viral pericarditis • Metastatic tumor • Uremia • Trauma • TB • Hemopericardium

  9. Clinic: • Beck’s triad • Hypotension may develop suddenly. • Subacute symptoms • Paradoxical pulse

  10. Laboratory: • ECG: • Low voltage • Electrical alternans • Chest X-ray • Echocardiogram

  11. Treatment: • Immediate Pericardiocentesis • Volume expansion • Pericardial window if… • Analysis of pericardial fluid.

  12. Constrictive Pericarditis • Healing & scar formation in some patients with pericarditis. • Viral, TB. • Previous cardiac surgery • Collagen vascular diseases • Radiation associated pericarditis

  13. Clinic: • Gradual onset of dyspnea, fatigue, pedal edema, abdominal swilling. • Symptoms of LV failure uncommon. • Tachycardia • Kussmaul’s sign • Broadbent’s sign • Pericardial knock • Hepatomegaly, ascites, peripheral edema.

  14. Laboratory: • ECG: • Low voltage • Atrial arrhythmias • CXR: • Pericardial calcification • Echocardiogram • CT or MRI

  15. Treatment: • Surgical stripping • Progressive improvement ensues over several months.

  16. Pericardial Effusion of Unknown Cause: • Skin test and cultures for TB. • Serum albumin and urine protein for nephrotic syndrome. • RFT for renal failure. • TFT for myxedema. • ANA for SLE and other CVD. • Search for primary tumor especially lung and breast.

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