m orning r eport friday september 3, 2010. p ericardium encloses heart ascending aorta pulmonary...
TRANSCRIPT
MORNING REPORTFriday September 3, 2010
PERICARDIUM
Encloses Heart Ascending aorta Pulmonary trunk Terminal segment of
the vena cavae Serous vs Parietal Fluid
Ultrafiltrate of plasma
PERICARDITIS
Infectious Autoimmune
Rheumatic fever Uremia Malignancy Drug reaction Post Surgical Idiopathic
VIRAL CAUSES
10 to 14 day prodromal illness
Respiratory or GI
Coxsackie Echo Adeno Epstein-Barr Influenza HIV
BACTERIAL CAUSES
Higher mortality Toxic
Higher fever Irritability
Cardiomegaly on CXR Spread from surgery or
infection Staph and H.flu
TB in immunocompromised
SIGNS AND SYMPTOMS
Chest pain Substernal, sharp, worse with inspiration,
relieved by sitting upright and leaning forward Radiation to scapular ridge
Friction rub Scratchy, high-pitched, to-and-fro
LABS
Elevation WBC ESR CRP Troponin
Myocardial involvement Specific Cause
Blood culture, viral culture, TB, RF, ANA
ECG
ECG
Stage 2 Normalization of the ST and PR segments
Stage 3 Development of widespread T-wave inversions
Step 4 Normalization of the T waves
PERICARDIAL EFFUSION
CXR “water-bottle heart”
Echo Support the diagnosis
MANAGMENT
Treat the underlying cause Alleviate pain and inflammation
NSAIDs Colchicine if recurrent or chronic (>2 weeks)
What about steroids? Controversial
Avoid Diuretics Avoid Intubation
COMPLICATIONS Recurrence
1/3 Constrictive pericarditis Cardiac tamponade
Tachycardia, hypotension, increased JVP, muffled heart sounds, hepatomegaly, narrow pulse pressure
Pulsus paradoxusElectrical alternans
STICK A NEEDLE IN IT!
Pericardiocentesis Hemodynamic compromise Cardiac tamponade Purulent pericarditis Neoplastic pericarditis
Pericardial window or pericardiectomy Resistant cases