pericarditis-21ydudbbbjgijj0515080610.pptx

Pericarditis

1. PERICARDITIS

2. Introduction Pericarditis  is swelling and irritation of the pericardium, the thin saclike membrane surrounding your heart.  The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other.

3. Pericarditis is inflammation of the pericardium, a sac-like structure with two thin layers of tissue that surround the heart to hold it in place and help it work. DEFINITION

4.   Pericarditis occurs after pericardectomy in 5 % - 30% patients. 1% - 3 % of cases develop after 10 days to 2 months after acute myocardial infarction.  In the developed world, viruses are believed to be the cause of about 85% of cases. In the developing world tuberculosis is a common cause but it is rare in the developed world. INCIDENCE

5.  Idiopathic Infections A.Viral - Adenovirus, EBV, CMV, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19 etc. B. Bacterial - Staphylococcus, Streptococcus, pneumococcus, Haemophilus, Neisseria ( gonorrhoeae or meningitidis ), Chlamydia ( psittaci or trachomatis), Legionella, tuberculosis, Salmonella etc. ETIOLOGY

6. C. Mycoplasma D. Fungal - Aspergillosis , blastomycosis , coccidiodomycosis , actinomycosis , nocardia , candida E. Parasitic - Echinococcus , amebiasis , toxoplasmosis F. Infective endocarditis with valve ring abscess ETIOLOGY

7. 3. Neoplasm A. Metastatic – Lung or breast cancer, Hodgkin's disease, leukemia , melanoma B. Primary – Rhabdomyosarcoma , teratoma,fibroma , lipoma , leiomyoma , angioma C. Paraneoplasm ETIOLOGY

8. 4. Cardiac A. Early infarction pericarditis B. Late postcardiac injury syndrome (Dressler's syndrome) C. Myocarditis D. Dissecting aortic aneurysm ETIOLOGY

9. 5.Autoimmune A. Rheumatic diseases – Including lupus, rheumatoid arthritis, vasculitis , scleroderma, mixed connective disease B. Other – Granulomatosis with polyangiitis (Wegener's), polyarteritis nodosa , sarcoidosis, IBD (Crohn's, ulcerative colitis), Whipple's Disease, giant cell arteritis, Behcet's disease,rheumatic fever ETIOLOGY

10. 6.Drugs Pericarditis can also develop from a drug-induced lupus syndrome caused by medications including procainamide , hydralazine , methyldopa, isoniazid , mesalazine , and reserpine . Doxorubicin: The anthracycline antineoplastic agents, such as doxorubicin and cyclophosphamide , have direct cardiac toxicity and can cause acute pericarditis ETIOLOGY

11. 6.Drugs Penicillin : Penicillin and cromolyn sodium, induce pericarditis through a hypersensitivity reaction Methysergide : Methysergide antimigraine drug belongs to the group of medicines known as ergot alkaloids. It causes constrictive pericarditis through mediastinal fibrosis ETIOLOGY

12. 7. Metabolic A. Hypothyroidism - Primarily pericardial effusion B. Uremia C. Ovarian hyperstimulation syndrome ETIOLOGY

13. Trauma A. Blunt, Penetrating B. Iatrogenic - Catheter and pacemaker perforations, cardiopulmonary resuscitation Radiation ETIOLOGY

14. BASED ON THE SYMPTOMS :- TYPES

15. Constrictive pericarditis Viral pericarditis Purulent pericarditis Tuberculous pericarditis Radiation Pericarditis   TYPES BASED ON THE CAUSES :- Traumatic pericarditis Serous pericarditis   Fibrous pericarditis Hemorrhagic pericarditis Adhesive mediastino pericarditis

16. Constrictive pericarditis When the pericarditis is associated with a thickening or scarring of the pericardial layers, this starts constricting the heart within the thoracic cavity, which in turn limits its effective functioning. This condition is known as constrictive pericarditis . TYPES

17. Viral pericarditis Viruses that cause pericarditis is known as viral pericarditis This kind of pericarditis is simple and can be handled as an outpatient procedure. Tuberculous pericarditis This condition is also seen in a very minor percentage of patients having pulmonary tuberculosis. Some of the developing countries remain the leading risk groups of tuberculous pericarditis . TYPES

18.   Purulent or suppurative pericarditis :- It is due to causative organisms may arise from direct extension, hematogenous seeding, or lymphatic extension, or by direct introduction during cardiotomy . Immunosuppression facilitates this condition. TYPES

19. Radiation Pericarditis This type of pericarditis is caused due to recent mediastinal radiation at any time from weeks to months after the exposure. Traumatic pericarditis Sharp or blunt trauma causes traumatic pericarditis . Invasive cardiac procedures also may give rise to this type of pericarditis , which includes cardiac diagnostic catheterization and electrophysiological ablation procedure. TYPES

20. Serous pericarditis It is usually caused by noninfectious inflammation such as occurs in rheumatoid arthritis and systemic lupus erythematosus . TYPES

21. Fibrous and serofibrinous pericarditis It represent the same basic process and are the most frequent type of pericarditis. Common causes include acute myocardial infarction (MI), postinfarction (including Dressler syndrome), uremia , radiation and trauma TYPES

22. Hemorrhagic pericarditis It involves blood mixed with a fibrinous or suppurative effusion, and it is most commonly caused by tuberculosis or direct neoplastic invasion. This condition can also occur in severe bacterial infections. Hemorrhagic pericarditis is common after cardiac surgery and may cause tamponade . The clinical significance is similar to suppurative pericarditis TYPES

23. Chronic pericarditis Adhesive mediastino pericarditis Is a reaction that usually follows suppurative or caseous pericarditis , cardiac surgery, or irradiation. This condition is rarely caused by a simple fibrinous exudate . The pericardial potential space is obliterated, and adhesion of the external surface of the parietal layer to surrounding structures occurs. TYPES

24. when microbes are inhaled or ingested, they migrate to myocardium and cause inflammation PATHOPHYSIOLOGY Accumulation of fluid in the pericardial sac called pericardial effusion. Compression of the heart Increased Intra Pericardial pressure Decreased ventricular filling and emptying Increased venous pressure De creased cardiac output De creased Arterial pressure Cardiac Failure