Pericardial Diseases

Dennis J. Esterbrooks M.D.

Pericardial Functions Maintain relation between right

and left ventricles Limit acute cardiac dilatation Facilitate atrial filling Anatomically anchor the heart Avoid spread of infection to the

heart

Disease of the Pericardium Acute pericarditis Pericardial tamponade Chronic constrictive pericarditis

Acute Pericarditis Definition

Acute Pericardial Inflammation Which Is Manifest As A Clinical Triad of Chest Pain, Pericardial Friction RubAnd ECG Changes

Common Etiologies of Pericarditis Idiopathic Viral Pyogenic Uremic Neoplastic Cardiac Injury Collagen Vascular Diseases

Acute Pericarditis Diagnostic Studies CBC Sed Rate FANA Blood Cultures Renal Function TB Skin Test

Acute Pericarditis Diagnostic Studies Chest X-Ray ECG Echocardiography

Pericarditis Acute ECG Changes

Pericarditis Evolutionary ECG Changes

ECG Acute Injury

ECG Early Repolarization

2-D Echo Pericardial Effusion

IF268.mov

Acute Pericarditis Management Bed Rest and Observation Non-steroidal Anti-inflammatory

Agent Steroids Pericardial Drainage

Pericardial Tamponade Definition

Elevated CVP Secondary to Compression of the Heart By Pericardial Fluid

Pericardial Effusion Rate of Accumulation

Tamponade Physiology

Pericardial Tamponade Physical Findings Elevated Jugular Venous Pressure Tachycardia Narrow Pulse Pressure Paradoxical Pulse “ Small Quiet Heart “

Pericardial Tamponade Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

Cardiac Tamponade

2-D Echo Tamponade

IF269.mov

Transmitral Flow Tamponade

Tamponade Paradoxical Pulse

Hemodynamics Tamponade

Pericardial Tamponade Management Fluid Expansion Inotropic Support Pericardial Drainage

Tamponade Pericardiocentesis

Chronic Constrictive Pericarditis Definition

Elevated CVP Secondary to Compression of the HeartBy the Pericardium

Constrictive Pericarditis Physical Findings Elevated Jugular Venous Pressure Kussmal’s Sign Pericardial Knock Narrow Pulse Pressure Hepatosplenomegaly Ascites Peripheral Edema

Constrictive Pericarditis Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

Constriction Chest X-Ray

2-D Echo Constriction

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Transmitral Flow Constriction

Venous Wave form Constriction

Cardiac Compression Venous Wave Forms

Hemodynamics Constriction

Constrictive Pericarditis Management The Sub acute Phase May Respond

to Non-steroidal Anti-inflammatory Agents

Chronic Constrictive Pericarditis Is Best Managed By Pericardial Stripping

Comparison of Tamponade and Constriction

------------------------------------------------------------------Feature Tamponade Constriction------------------------------------------------------------------

Effusion Present AbsentCalcification Absent Often PresentDip-plateau Inconspicuous ProminentVenous Waveform X or Xy XY or xYPulses Paradox Present InconspicuousKussmal’s Sign Absent Often PresentPericardial Knock Absent Often Present

Echocardiography Effusion

Echocardiography Tamponade

Echocardiography after Pericardiocentesis

Echocardiography Constriction

Echocardiography Tamponade