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Pericardial disease

  • 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
  • Definition: Inflammation of the pericardium.
  • Etiology: Viral (e.g., coxsackievirus), post-MI, post-cardiac surgery, autoimmune, tuberculosis, malignancy.
  • Symptoms: Chest pain (sharp, pleuritic, improving with sitting up), fever.
  • Signs: Pericardial friction rub.
  • ECG: Widespread ST elevation and PR depression.
  • Treatment: NSAIDs, colchicine, and treat underlying cause.
Pericardial Effusion
  • Definition: Accumulation of fluid in the pericardial space.
  • Etiology: Inflammation, infection, malignancy, trauma, renal failure, hypothyroidism.
  • Symptoms: Asymptomatic to dyspnoea, chest pain, cough.
  • Signs: Distant heart sounds, hypotension, tachycardia.
  • Investigations: Echocardiogram (diagnostic of choice), ECG, CXR.
  • Treatment: Pericardiocentesis if symptomatic or tamponade present.
Cardiac Tamponade
  • Definition: Compression of the heart by an accumulation of fluid in the pericardial sac.
  • Symptoms: Dyspnoea, chest pain, anxiety.
  • Signs: Beck’s triad (hypotension, distended neck veins, muffled heart sounds), pulsus paradoxus.
  • Investigations: Echocardiogram, ECG (low voltage QRS, electrical alternans).
  • Treatment: Emergency pericardiocentesis, surgery.
Constrictive Pericarditis
  • Definition: Chronic inflammation leading to a thickened, fibrotic, adherent pericardium restricting diastolic filling.
  • Etiology: Tuberculosis (common worldwide), previous cardiac surgery or radiation, viral pericarditis, rheumatoid arthritis.
  • Symptoms: Fatigue, dyspnoea, oedema.
  • Signs: Raised JVP, Kussmaul’s sign, pericardial knock, hepatomegaly.
  • Investigations: CT/MRI, echocardiogram, cardiac catheterization.
  • Treatment: Diuretics for symptom relief, surgical pericardiectomy for definitive management.

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