Acute pericarditis : Pericardial Disease ppt
power point presentation
Idiopathic (idio and pathy) – 86%
Infective (viral or bacterial) – 7%
Following a myocardial infarction or cardiac surgery (Dressler’s syndrome)
Neoplastic disease (commonly lung or breast) – 6%
Signs, Symptoms and Investigations
Think about how an inflamed, thickened pericardium might affect the hearts function – how can we diagnose this?
Catheter laboratory investigations
- Retrosternal chest pain – sharp worse on insp and lying flat
- Friction rub (high pitched scratching noise)
- Raised jugular venous pressure
ECG differential diagnosis – MI
What leads is the ST elevation in?
What shape is the elevation?
Are there Q waves?
Do the ST –T changes evolve with time?
History of the patient
Cardiac enzymes etc
But remember that you can get more than one pathology
at the same time!
Clinical signs differential diagnosis – pleurisy
Pleuritic pain has similar sharp quality but is usually more specific in location
Pleural rub is heard over the area where the pain occurs
Diagnosis of pericarditis
Patient will have 2 or more of the following;
–Characteristic chest pain
–Pericardial friction rub (auscultation)
–ECG showing characteristic ST elevation (caused by epicardial injury)
- NB. Search for the underlying disease
- No good evidence from randomised controlled trials
- Patients require bed rest
- NSAID (aspirin, indomethacin) are generally accepted as effective for relieving symptoms of chest pain
- NSAID ketorolac tromethamine rapid results
- Colchicine may be a useful adjunct in those who do not respond to NSAIDs alone
- Pericarditis is usually a benign disorder
- Diagnosis relates to underlying cause
- But any cause can lead to an effusion and tamponade which can lead to death
- Pericarditis can also progress to pericardial constriction and heart failure