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Exam Cram
Exam Cram
Pericardium is the connective tissue surrounding the heart and pericarditis types: acute or chronic (constrictive)
Presentation (acute): chest pain worse leaning forward (can be pleuritic), concave/ saddle ST elevation, mildly raisd troponins, recent viral illness
Diagnosis: clinical usually (can be made on ECHO findings)
Acute pericarditis management: NSAIDs/ colchichine/ aspirin
Diseases of the Pericardium
Diseases of the Pericardium
Pericarditis
Acute pericarditis
Constrictive (chronic)
Acute Pericarditis
Acute Pericarditis
Background
Background
Pericarditis describes inflammation of the pericardium, the connective tissue surrounding the heart
Assessment
Assessment
History:
Recent viral infection
Pleuritic chest pain, better leaning forward
Sob, mild feverish
Examination:
Investigations
ECG:
ST elevation: saddle shaped, concave- widespread
PR depression
T wave flattening (later sign)
Raised troponin and inflammatory markers (CRP, neutrophils)
ECHO: pericardial inflammation
Diagnosis
Diagnosis
Diagnostic criteria: 2/4 (European College of Cardiology)
Chest pain
Pericardial rub
Pericarditis ECG changes
Pericardial effusion
Differentials: NSTEMI , Pulmonary Embolus, Pneumomia
Aetiology:
Idiopathic (primary)
Secondary
Management
Management
Acute
NSAIDS & paracetamol
Consider colcichine or prednisolone or aspirin
IL-1 inhibitors: anikara/ canalizumab
Colcichine- treats acute pericarditis but also reduces chance of future episodes, advised 6m course
Nil NSAIDs in post MI pericarditis due to preventing recovery.
Complications
Constrictive Pericarditis
Constrictive Pericarditis
Background
Background
Complication of acute pericarditis causing the pericardium to loose its elasticity causing diasytolic dysfunction, usually a chronic irreversible process
Results in HFpEF
Assessment
Assessment
History
1yr gradual sob, fatigue
Swollen legs, unable to lie flat to sleep
Examination
Hepatomegaly and later ascites
Pericardial knock 50%
Pleural effusion, peripheral oedema, raised JVP
Investigations
ECHO- diastolic dysfunction
Diagnosis
Diagnosis
Diagnostic criteria: ECHO findings
Classification (aetiology):
Complication of pericarditis or tamponade
Systemic conditions: amyloidosis, SLE, Rheumatoid Arthritis
Commonest cause worldwide
Pericardial fluid: lymphocytosis
Management
Management
Chronic
Treat underlying cause
As per HFpEF
Furosemide, Empagliflozin
Definitions
Definitions
Pericardial Diseases
Pericarditis- acute reversible damage to pericardium
Constrictive pericarditis- chronic irreversible changes
Pericardial effusion and tamponade- fluid in pericardial space
Myocardial Diseases
Myocarditis- acute reversible damage to myocardium
Cardiomyopathy Phenotypes- long term irreversible damage to cardiac myocardium.
Dilated
Restrictive
Hypertrophic: HOCM
Endocardial Diseases
Non infective endocarditis
Resources and References
Resources and References
Yadav NK, Siddique MS. Constrictive Pericarditis. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459314/
Links
Speciatly: cardiology
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