3 Pericarditis (Dr. Linao) PDF

Normally has up to 50% of serous CARDIAC MRI fluid LABORATORY RESULTS: ESR- 70mm/hr High resolution CRP- 9.330mg/dL ACUTE PERICARDITIS Sputum AFB x 2- n...

Normally has up to 50% of serous CARDIAC MRI fluid LABORATORY RESULTS: ESR- 70mm/hr High resolution CRP- 9.330mg/dL ACUTE PERICARDITIS Sputum AFB x 2- negative CAUSE, EPIDEMIOLOGY, AND PATHOPHYSIOLOGY: TB genexpert/MTB PCR- negative signs and symptoms resulting from pericardial TB IGRA- negative Patient was discharged inflammation of no more than 1 to 2 weeks improve duration most cases are idiopathic (no specific cause, presumed viral) DISCHARGE DIAGNOSIS: Constrictive Effusive Pericarditis secondary to viral infection tests for specific viruses is not routine: ○ cost CASE MANAGEMENT Constrictive Pericarditis ○ low yield ○ negligible impact on management Many undiagnosed cases ANATOMY AND PHYSIOLOGY OF PERICARDIUM: 1% at autopsy 5% of patients at ED with nonischemic chest pain TB pericarditis- chronic symptoms Bacterial pericarditis- critically ill Dressler syndrome- declined during reperfusion era Uncomplicated: inflammation of pericardial tissue Complicated (15%) ✓ Associated with myocarditis ✓ Modest release of troponin I LVdysfunction is rare Excellent long-term prognosis TWO LAYERS 1. VISCERAL PERICARDIUM Monolayer of mesothelial cells Collagen and elastin fibers that is adherent to epicardial surface ofheart 2. PARIETAL LAYER Fibrous layer Acellular contains collagen and elastin fibers ~2mm thick Surrounds most of the heart PERICARDIAL SPACE/ SAC Contained between parietal and visceral layers Transcribed by: DEDASE 5  HISTORY AND DIFFERENTIAL DIAGNOSIS present: Chest radiograph CHEST PAIN: severe, pleuritic, rapid onset, Hemogram substernal/left anterior aspect of hsCRP chest/epigastrium, radiation on left arm, Echocardiogram trapezius ridge, relieved by sitting forward, Troponin I worsened when lying down Consider serum ANA if the patient is a young female 3. If the diagnosis is likely or certain, initiate PHYSICAL EXAMINATION therapy with an NSAID plus colchicine Uncomfortable Anxious LABORATORY TESTING Low grade fever Sinus tachycardia Hemogram: modestly elevated WBC count Friction rub with mild lymphocytosis (Pathognomonic) “walking on a crunchy snow” elevated Troponin I-15% no LV dysfunction: most cases hsCRP: elevated ~3/4 of patients HISTORY AND DIFFERENTIAL DIAGNOSIS CHEST X RAY- usually normal Cough - small infiltrates Dyspnea - pleural effusion Hiccoughs Echocardiography- normal in most with acute Antecedent viral illness idiopathic pericarditis History of cancer or an autoimmune disorder, Detect pericardial effusion high fevers with shaking chills,rash, and MRI/CT: pericardial thickening weightloss (specific diseases) Increased gadolinium uptake (active Pneumonia inflammation) Pulmonary embolism/infarction Costochondritis NATURAL HISTORY AND MANAGEMENT Gastroesophageal Reflux disease Aortic dissection NSAIDS: 10 to 14 days Intra-abdominal processes ○ Ibuprofen (600-800mg TID) Pneumothorax ○ Acetylsalicylic acid (2-4gm daily in Herpes zoster pain divided doses) Precede silent MI Colchicine: prevention of recurrence and unresponsive to NSAIDS,given for 3 months Dose: TABLE 71-2 INITIAL APPROACH TO PATIENTS WITH ○ >70 kg 0.5mg BID DEFINITE OR SUSPECTED ACUTE PERICARDITIS ○