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Pericardial disease

Overview

  • The pericardium is a double-walled sac containing the heart and the roots of the great vessels.
  • Pericardial disease encompasses various conditions affecting the pericardium including pericarditis, pericardial effusion, and constrictive pericarditis.

Acute Pericarditis 

Background Knowledge 🧠

Definition

  • Inflammation of the pericardium.

Aetiology

  • Viral (e.g., coxsackievirus)
  • Post-MI
  • Post-cardiac surgery
  • Autoimmune
  • Tuberculosis
  • Malignancy

Clinical features πŸŒ‘️

Symptoms

  • Chest pain (sharp, pleuritic, improving with sitting up)
  • Fever

Signs

  • Pericardial friction rub

Investigations πŸ§ͺ

Investigations

  • ECG: Widespread ST elevation and PR depression.
  • Echocardiogram
  • Bloods: FBC, inflammatory markers (e.g. CRP)

Management πŸ₯Ό

Management

  • NSAIDs, colchicine, and treat underlying cause.

Pericardial Effusion 

Background Knowledge 🧠

Definition

  • Accumulation of fluid in the pericardial space.

Aetiology

  • Inflammation
  • Infection
  • Malignancy
  • Trauma
  • Renal failure
  • Hypothyroidism

Clinical features πŸŒ‘️

Symptoms

  • Asymptomatic to dyspnoea, chest pain, cough.

Signs

  • Distant heart sounds
  • Hypotension
  • Tachycardia

Investigations πŸ§ͺ

Investigations

  • Echocardiogram (diagnostic of choice)
  • ECG
  • CXR

Management πŸ₯Ό

Management

  • Pericardiocentesis if symptomatic or tamponade present.

Cardiac Tamponade 

Background Knowledge 🧠

Definition

  • Compression of the heart by an accumulation of fluid in the pericardial sac.

 

Aetiology

  • Infection (e.g. Tuberculosis)
  • Post-cardiac surgery
  • Aortic dissection
  • Malignancy
  • Trauma
  • Post-MI
  • Autoimmune (e.g. SLE)

Clinical features πŸŒ‘️

Symptoms

  • Dyspnoea
  • Chest painΒ 
  • AnxietyΒ 

Signs

  • Beck’s triad (hypotension, distended neck veins, muffled heart sounds)
  • Pulsus paradoxus

Investigations πŸ§ͺ

Investigations

  • Echocardiogram
  • ECG (low voltage QRS, electrical alternans)

Management πŸ₯Ό

Management

  • Emergency pericardiocentesis, surgery

Constrictive Pericarditis 

Background Knowledge 🧠

Definition

  • Chronic inflammation leading to a thickened, fibrotic, adherent pericardium restricting diastolic filling.

Aetiology

  • Tuberculosis (common worldwide)
  • Previous cardiac surgery or radiation
  • Viral pericarditis
  • Rheumatoid arthritis

Clinical features πŸŒ‘️

Symptoms

  • Fatigue
  • Dyspnoea
  • Oedema

Signs

  • Raised JVP
  • Kussmaul’s sign
  • Pericardial knock
  • Hepatomegaly

Investigations πŸ§ͺ

Tests

  • CT/MRI
  • Echocardiogram
  • Cardiac catheterization

Management πŸ₯Ό

Management

  • Diuretics for symptom relief
  • Surgical pericardiectomy for definitive management

References

Jesper K. Jensen’,’Steen Hvitfeldt Poulsen’,’Henning MΓΈlgaard (2017). Cardiac tamponade: a clinical challenge. Escardio.org, [online] 15(17). Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Cardiac-tamponade-a-clinical-challenge#:~:text=Acute%20cardiac%20tamponade%20is%20usually,aortic%20dissection%20or%20is%20iatrogenic.

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