Pericardial Disease Pericardial Disease.pptx

Pericardial Disease

1. Pericardial Disease 20.12.23

2. Acute pericarditis Acute pericarditis is an inflammation of the pericardium characterized by pericarditic chest pain, pericardial friction rub, and serial electrocardiographic (ECG) changes ( eg , new widespread ST-elevation or PR depression; new/worsening pericardial effusion).    The first and last stages of ECG changes are seen in the images below.

3. Etiology Idiopathic causes Infectious conditions, such as viral, bacterial, and tuberculous infections Inflammatory disorders, such as RA, SLE, scleroderma, and rheumatic fever Metabolic disorders, such as renal failure and hypothyroidism Cardiovascular disorders, such as acute MI, Dressler syndrome, and aortic dissection Miscellaneous causes, such as iatrogenic, neoplasms, drugs, irradiation, sarcoidosis , cardiovascular procedures, and trauma

4. Diagnosis Initial evaluation includes a clinical history and physical examination, ECG, echocardiography, chest radiography, and lab studies. ECG can be diagnostic in acute pericarditis and typically shows diffuse ST elevation Echocardiography is indicated if pericardial effusion is suspected on clinical or radiographic grounds, the illness lasts longer than 1 week, or myocarditis or purulent pericarditis is suspected. A chest radiograph is helpful to exclude pulmonary conditions that may be responsible for or are associated with the cause of pericarditis ( ie , cancer, infection, SLE, sarcoidosis , etc ). It is not helpful for evaluating the presence of pericardial fluid, as patients with small effusions (less than a few hundred milliliters) may present with a normal cardiac silhouette; it is only helpful for diagnosing fluid in patients with effusions larger than 250 mL.

5. Laboratoty tests Laboratory tests may include CBC; serum electrolyte, blood urea nitrogen (BUN), and creatinine levels; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels; and cardiac biomarker measurements, lactate dehydrogenase (LDH), and serum glutamic- oxaloacetic transaminase (SGOT; AST) levels. Serum titers for suspected infectious etiologies and testing for tuberculosis exposure ( ie , PPD or interferon-gamma release assays) may be helpful

6. Management Treatment for specific causes of pericarditis is directed according to the underlying cause. For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstays of therapy. NSAID agents have a similar efficacy, with relief of chest pain in about 85-90% of patients within days of treatment. A full-dose NSAID should be used, and treatment should last 7-14 days. Colchicine, alone or in combination with aspirin or an NSAID, can be considered as first-line therapy as an adjunct for patients with acute pericarditis, particularly to prevent recurrences.

7. Signs and symptoms Chest pain is the cardinal symptom of pericarditis, usually precordial or retrosternal with referral to the trapezius ridge, neck, left shoulder, or arm. Common associated signs and symptoms include low-grade intermittent fever, dyspnea/tachypnea (a frequent complaint and may be severe, with myocarditis, pericarditis, and cardiac tamponade ), cough, and dysphagia. In tuberculous pericarditis, fever, night sweats, and weight loss are commonly noted (80%).

8. Cardiac tamponade Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complications of which include pulmonary edema, shock, and death.

9. Symptoms Symptoms vary with the acuteness and underlying cause of the tamponade . Patients with acute tamponade may present with dyspnea, tachycardia, and tachypnea. Cold and clammy extremities from hypoperfusion are also observed in some patients. Other symptoms and signs may include the following

10. Diagnosis Prompt diagnosis is key to reducing the mortality risk for patients with cardiac tamponade . Although echocardiography provides useful information, cardiac tamponade is a clinical diagnosis. Echocardiography can be used to visualize ventricular and atrial compression abnormalities as blood cycles through the heart.

11. Manegement Removal of pericardial fluid is the definitive therapy for tamponade and can be done using the following three methods: Emergency subxiphoid percutaneous drainage Pericardiocentesis (with or without echocardiographic guidance) Percutaneous balloon pericardiotomy The role of medication therapy in cardiac tamponade is limited.