Pericardial Diseases PDF

# Pericardial Diseases ## 1. Acute Pericarditis ### Causes * Idiopathic. * Infection (most common): Coxsackie virus, Fungal, or bacterial: TB. * Uremia (Uremic pericarditis in renal failure is an indication for dialysis). * Hypothyroidism. * MI. * Autoimmune arthritis and SLE. ### Clinical Pres...

# Pericardial Diseases ## 1. Acute Pericarditis ### Causes * Idiopathic. * Infection (most common): Coxsackie virus, Fungal, or bacterial: TB. * Uremia (Uremic pericarditis in renal failure is an indication for dialysis). * Hypothyroidism. * MI. * Autoimmune arthritis and SLE. ### Clinical Presentation * Symptoms: Pleuritic chest pain that gets worse by lying flat and relieved by sitting forward. * Signs: O/E: Pericardial friction rubs. ### Investigations * CBC, ESR * ECG: * Global concave (saddle shaped) ST segment elevation. * But the most specific ECG finding is PR depression. ### Management * First Line: NSAID (ibuprofen) + treatment of underlying cause. * Second line is colchicine (colchicine prevents WBCs migration to site of inflammation) + treat underlying cause. * Steroids are only given in severe cases because it decreases immunity. ## 2. Pericardial Effusion ### Causes: * Same as acute pericarditis. ### Clinical Features: * Ewart sign: bronchial breathing in the base of Lt lung, (because the pericardium contains fluids that compress the base of Lt lung (Lt lung looks like it is collapsed)). ### Diagnosis * ECG: Two findings: * Low voltage QRS * Electrical alternans: This short QRS complex has an altered height, sometimes it is short and sometimes it is even shorter, this is because the heart is floating on water and has an unstable, fluctuating position. * CXR: enlarged heart (cardiomegaly). * Echo: the DIAGNOSTIC test, there is echo free zone around the heart. ### Treatment * By treating the underlying cause. * Pericardiocentesis may be used as diagnostic and therapeutic. ### Note: * Chest pain may be cardiac or pleuritic: * **Cardiac chest pain:** * Central, crushing, radiating to jaw or Lt arm. * Increases by exercise, heavy and fatty meals, stress and emotions, and cold. * Relieved by rest, or sublingual nitrates. * **Pleuritic chest pain:** * Sharp, localized pain. * Aggravated by deep inspiration and cough. ## 3. Constrictive Pericarditis: ### Differential Diagnosis of ST segment elevation: * **1. Pericarditis:** ST elevations is global (in all leads), and Saddle (concave) shaped. * **2. MI:** ST elevation is localized to certain leads, and it is convex in shape.