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Questions and Answers
What is a primary factor that excludes a diagnosis of acute pericarditis?
Which physical examination finding is primarily associated with pericarditis?
Which condition is NOT a high-risk indicator for pericarditis?
Which of the following ECG characteristics differentiates acute pericarditis from acute ischemia?
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What is a common treatment option for managing myopericarditis?
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How is T-wave inversion in pericarditis typically characterized?
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Which symptom is least likely to be associated with myopericarditis?
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What distinguishes the cardiac tamponade from other pericarditis presentations?
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What is the primary treatment option for patients diagnosed with constrictive pericarditis?
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What is one of the common causes of constrictive pericarditis?
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Which clinical finding is more indicative of myopericarditis compared to acute pericarditis?
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What electrocardiogram (ECG) change is typically seen in acute pericarditis?
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Which symptom is more common in acute pericarditis than in a myocardial infarction?
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Which condition is characterized by the presence of pericardial fluid causing pressure on the heart?
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What distinguishing feature separates the chest pain of pericarditis from myocardial infarction?
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What should be done for high-risk patients presenting with acute pericarditis?
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Which of the following treatments is recommended for recurrent pericarditis when initial therapies have failed?
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What is a common cause of constrictive pericarditis?
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How is myopericarditis differentiated from pericarditis?
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What physiological change occurs in the pericardium during constrictive pericarditis?
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Which of the following is not a typical treatment for acute pericarditis?
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At what weight is the dosage of colchicine adjusted in the treatment for recurrent pericarditis?
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Which imaging method can provide confirmatory findings for recurrent pericarditis in atypical cases?
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What percentage of patients with idiopathic acute pericarditis who are untreated develop recurrent pericarditis?
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Study Notes
Aortic and Mitral Regurgitation
- The structure that prevents excess dilation of the heart in cases of aortic and mitral regurgitation is not mentioned in the text provided.
Diseases of the Pericardium
- Pericarditis is the inflammation of the pericardium.
- Pericardial effusion is the accumulation of fluid in the pericardial sac.
- Cardiac tamponade occurs when the pericardial effusion puts pressure on the heart, restricting its ability to pump blood effectively.
- Constrictive pericarditis is a condition where the pericardium becomes thickened and fibrotic, restricting the heart's ability to fill with blood.
- Masses within the pericardium can cause various symptoms and complications.
- Congenital absence of the pericardium is a rare condition where individuals are born without part or all of the pericardium.
Pericarditis
- Most common cause of pericarditis is infectious (usually viral).
- Other causes include idiopathic, inflammatory (usually autoimmune), metabolic (uremia), recent MI (Dressler's syndrome), and metastatic cancer.
Clinical Presentation of Acute Pericarditis
- Pleuritic and positional, retrosternal chest pain, often worsened by lying supine and relieved by sitting and leaning forward.
- Pericardial friction rub is a characteristic sound heard with a stethoscope, typically over the left sternal border.
- ECG changes include diffuse ST elevation or PR depression.
- Pericardial effusion may develop.
Chest Pain in Pericarditis vs. Infarction
- Pericarditis pain is more likely to be sharp and pleuritic, worsened by coughing, inspiration and swallowing.
- Pericarditis pain is worse by lying supine and relieved by sitting and leaning forward.
ECG Changes in Pericarditis
- Typical ECG changes include PR depression and concave ST-elevation.
ECG Differences in Pericarditis vs. Ischemia
- In pericarditis, ST segment deflections have convex shaped rising legs of the T waves, compared to concave in ischemia.
- ECG changes in acute ischemia are region-specific, while in acute pericarditis, changes are diffuse.
- There are no reciprocal changes in pericarditis, unlike ischemia.
- Pericarditis does not lead to infarct patterns such as Q waves or loss of R waves.
- T-wave inversion might occur in acute ischemia with elevated ST segments, but it is uncommon in acute pericarditis.
Pericardial Friction Rub
- High frequency sound best heard with a stethoscope diaphragm, lying supine and at the end of expiration.
- Characterized by three sounds: one systolic and two diastolic.
Pericardial Effusion
- High-risk patients with an initial episode of acute pericarditis should be hospitalized to determine the cause and monitor for cardiac tamponade.
- Close follow-up is critical for patients not hospitalized.
High-Risk Criteria for Pericarditis
- Major criteria include:
- Fever greater than 38°C
- Subacute onset
- Large pericardial effusion
- Cardiac tamponade
- Lack of response to NSAIDs/ASA after 1 week
- Minor criteria include:
- Myopericarditis
- Immunosuppression
- Trauma
- Oral anticoagulant therapy
Management of Pericarditis
- Initial investigations for all suspected patients include physical exam, ECG, chest x-ray , echocardiogram, CRP and troponin.
- Special investigations are recommended for patients with high-risk criteria, including exploring the epidemiological background.
- Patients with high-risk criteria warrant hospital admission and inpatient treatment.
Treatment of Pericarditis
- Treat underlying cause.
- Use anti-inflammatory drugs:
- NSAIDs/ASA: CRP-guided (1-2 weeks), protect gastrointestinal system.
- Colchicine: prevents recurrence, dosage of 2x1 for >70kg for 3 months.
- Prednisone: for recurrent or autoimmune causes, not recommended as first-line therapy.
- Restrict exercise.
Recurrent Pericarditis
- 15-30% of patients with idiopathic acute pericarditis not treated with colchicine experience recurrent pericarditis.
- 50% of patients with recurrent disease will have at least one further recurrence.
- Inadequate treatment of the initial episode is a common cause of recurrence.
Therapy for Recurrent Pericarditis
- Corticosteroids for patients with insufficient response to initial double therapy.
- Myopericarditis: Pericarditis with suspected myocardial involvement.
- Perimyocarditis: Predominant myocarditis with pericardial involvement.
Constricted Pericarditis
- Scarring of the visceral and parietal layers restricting cardiac chambers.
- Causes include tuberculosis, idiopathic or viral pericarditis, mediastinal irradiation, open-heart surgery, chronic renal failure, and connective tissue disorders.
Physiology of Constriction
- The pericardium acts as a calcified shell.
- Decreased compliance leads to:
- Rapid early diastolic filling
- Impaired late diastolic filling
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Description
This quiz covers critical topics related to aortic and mitral regurgitation, as well as diseases of the pericardium. It includes essential definitions such as pericarditis, pericardial effusion, and cardiac tamponade, providing a comprehensive understanding of these cardiac conditions.
