18926 pericarditis

8/2/2019 18926 pericarditis

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PericarditisPericarditis



DefinitionDefinition::

Is inflammation of pericardial layer of the heart. pericardial layer covers the

heart and protect it from anyinfection.



A . Viral infection: this is the most important cause in infection coxachi A virus.

A nd B commonest one. B3 , B5.ECHO virus, influenza V. hepatitis V.

B. Bacterial infection Tubercle bacilli

Staphylo coccus

Strepto coccus

Pneumo coccus

CausesCauses::I. Infection: is the most important cause:



C.Fugal Infection

D.Parasitic InfectionThose causes same as the causes of myocordotis and so the patient with

acute myocarditis can present withpericarditis and vice versa that thedisease could start in the myocardium

and spread to the pericardium.



II. Hyper sensitively reaction.

Follow myocardial infarctiondressler syndrome ).post

pericardits 2nd

ry to M.I in 3rd

or 4th day of infection.(latepresentation ).



Post pericardiotomy syndrome .auto

immune self limiting disease affect pleuraand pericardium .common after cardiacsurgery specially mitral valve ³mitralcomissuratomy´

Serum sickness and drug reaction as(hydralazine)

III. Direct and indirect wound as

stab wound .



Iv.Metabolic disorders as uraemia. (most

important). Present with pericaditiseffusion and espically after introduction of renal dialysis .Thepericardial effusion enhanced after renal dialysis .

v.Myxedema.vi.Malignancy like lymphoma.

vii.Aortic dissection + myocardialinfection.



viii. Cobalt pear cardiomyopathy. Pear can.Lead to

ix. Radiation therpay .

Myocarditiscardiomyopathy



Clinical FindingClinical FindingDepond on the:

- Type of inflammation.

- Sevirety of inflammation.

- Formation of pericardial fluid.

1. Dry pericarditis.

2. Percardial effusion without cardiac temponade.

3. Cardiac temponade.

4. Pericardial constriction.



ECG:ECG:



1/ Dry Pericarditis or Fibronous:1/ Dry Pericarditis or Fibronous:

Chest pain:

It is precardial, sever, radiate to shoulder, so mimic theacute myocardial infraction pain. But the pain of pericarditis increase intensity with inspiration or lyingflat and improve when standing or sit down or leaningforward ( ) .

Fever: A rthralgia rigors, anxiaty and general weakness.

Symptoms:Symptoms:



Signs:

Pericardial rub: Is the harsh sound continuousatrail systole, Ventricular systole and ventriculardiastole. It is superficial sound has no relation toheart sound. Nearly periodical area. and easy to

heard when the patient hold its breathing soyou should differentiate between pleural rub andpericardial rub. Pleural rub might be heardduring inspiration. Pericardial rub start todisappear when effusion develops. A ndpericardial pain improve.



Lab Finding:Lab Finding:

1. CBC leu kocytosis 20.000.

increase sedmentation rate.

Increase CRP



XX--Ray:Ray:

Normal chest X-Ray.

No signs of cardiac enlargement.

No signs of pulmonary congestion.



ECHO:ECHO:



SymptomsSymptoms:: disapperance of cheast pain.

1. ECG changes - Flat T wave.

- Low voltage ECG

22 / Precardial effusion without temponade: / Precardial effusion without temponade:



Signs:Signs:

- Blood pressure normal.

- Pulse normal.

-Only heart sound become distant.

- Invisible cardiac pulse.

- Pericardial rub might disappear orit may remain and this indicationto previous pericarditis so no pain

and no rub.



ECG:ECG:

Change in T wave not specific for P. effusion.

T wave flat or T wave inverted.

Low voltage. Low QRS complex.



ECHO:ECHO:

It is 99% diagnostic to pericardial effusion.

ECHO: Showed free area between

pericardium and posterior wall of L.ventricle.



The ECHO not useful in early stage of dry

pericarditis but in late when there isfibrosis.



Differential DiagnosisDifferential Diagnosis

3rd heart sound. Normal heart

sound. In the pericardialeffusion there is distant heart sounds and apical impulse not

visible.

Heart failure:



Complication of pericardial effusion:Complication of pericardial effusion:

1. Cardiac temponade

2. Fibrosis:

minimal effusion and this called seroconstrictive or sub acute inflammation.



Treatment of pericarditis without effusion:Treatment of pericarditis without effusion:

1. Salicylate NSID in high dose.

2. Bed Rest.

most patient respond to those points. If patient after 10 day of starting salicylate orNSIDrugs if still have signs or symptoms of pericarditis corticosteroids can be added

but role of corticosteroids is doubt if start from beginning of the disease.



Treatment of pericardial effusion:Treatment of pericardial effusion:

1. Pericardio- synthesis:This is diagnostic and therapeutic.

2. Thoracotomy:( an open drainage).



33 / Cardiac Temponade: / Cardiac Temponade:

In Temponade the amount of fluid inside pericardial sacis increased. When intra pericardial pressure equal to thediastolic pressure in the heart. ( the right vertical or right

atrial pressure) then temponade develops. The right side of the heart has less diastolic pressure

than left side of the heart and for that reason the cardiactemponade compress right side of the heart because thepressure reach to diastolic pressure of right ventricle or

right atrium before reach to left ventricle and so allpatients present with right side heart failure heart problem.



Symptoms:Symptoms:

Patients is unconscious, severly sweating,dizzness or may reach a circulatory shock.



- Increase venous pressure :

- Cardiac impulse: A re not palpable.

- Heart sound: A re distant and this is same as P. effusion.

Signs:Signs:

(Kussmauls sign). called inspiratory filling of superior vena cava.



ECG:ECG:

- Low voltage and T wave change.

- Non specific change.



ECHO:ECHO:

Is most helpful diagnotic method forcardiac tamponade.

Fluid inside between pericardium andposterior wall of ventride.



Invasive Method:Invasive Method:

Abscent.Y Descend:C.Tamponede the diastolic pressure in thepericardial sac equal to diastolic pressure in Rt ventricle and so there is interference with thefilling of Rt ventricle and so absent of Y descent.For that reason it is an acute emergency we

would remove fluid to give chance to Rt ventricleto dilate.



Differentia DignosisDifferentia Dignosis

From severly P. Emblism or acutemyocardial infraction or any acute

emergency state. Type of pain is similar

But pain of pericardial when lying flat.



ECGECG::



Treatment:Treatment:

11.. pericardio syntheasis:pericardio syntheasis:



4. Constrictive Pericardits4. Constrictive Pericardits

There is sero constrictive andconstrictive pericarditis. The differencebetween them, that the sero contrictive

affect Rt pericardium + minimal fluid inpericardiuml so we called it seroconstrictive or sub acute type.

In constrictive pericarditits, wholepericardium is thickened and fibrosis somake thick fibrous layer around heart.



Symptoms:Symptoms:

Is swelling of abdomen and lowerlimb as it mimic presentation asacute Rt heart failure.



Dyspnea is minmal in constrictive

pericarditis is not presenting symptom but it can occur.

A naroxia.

General weakness + wasting.

In constrictive pericarditis, the history of previous attack of pericarditis is important.



Signs:Signs:

- Low blood pressure.- Pulsus paradoxus:

Is present in constrictive pericarditis andcardiac tamponade and abscent inpericardial effusion without tamponadeand in dry pericarditis.

- (it is change in sytolic blood pressure

more than 10 mm of Hg during insiration).



-

Arrythmia:( A trail Fibrillation) in 30% in constrictivepericarditis ( one of causes of artailfibrillation is constrictive pericarditis) high

jaqular venous pressure.

- No deep Y wave descent :

This opposite to constrictive pericarditiswhen there is Y wave (deep descent).



Rigt hypocondrial pain:Rigt hypocondrial pain:



But in constrictive dilated Rt ventricle at early diastolic rapidy and there is Y rapiddescent until the pressure inside Rt ventricle equal to whole distolic pressure

in the pericardium so there is squair root phenomena.

Percardial knock:

A scitis:



ECG:ECG:

Non specific.



XX--Ray:Ray:

Intraprecardial cacification



ECHO:ECHO:

A bsent of late diastolic filling.



D.DD.D

Superior venacaval ospstruction.

Restrective cardiomyopathy.

Endomyocardial fibrosis.



Treatment:Treatment:

PericardiutomyPericardiutomy

18926 pericarditis

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