1) Anatomy of pericardium
2) Overview of pericardial disease
3) Clinical presentation
4) Acute pericarditis
5) Chronic per...
 Normal amount of
pericardial fluid: 15-50
cc
 Two layers:
 Outer layer is the parietal
pericardium and consists
of lay...
 Fibroelastic sac
consisting of 2 layers
 Visceral at
epicardial side
 Parietal at
mediastinal side
 Pericardial fluid...
 Acute Pericarditis
 Chronis pericarditis
 Pericardial Effusion
1)Infection
2)Radiation
3)Neoplasm
4)Myocardial intrinisic disease
5)Trauma
6)Autoimmune
7)Drugs
8)Metabolic
*viral, autor...
Viral
-adenovirus
-enterovirus
-cytomegalovirus
-influenza
-hepatitis B
-herpes simplex
-echovirus
-mumps
Mycoplasma
Funga...
Radiation
Neoplasm
-metastatic
-primary cardiac
-paraneoplastic
Cardiac
-early infarction
-Dressler’s
-myocarditis
-aortic...
Drugs
-drug induced lupus
hydralazine
isoniazid
procainamide
-doxorubicin
-phenytoin
Metabolic
-hypothyroid
-uremia
-ovari...
 Serous
 Fibrinous
 Purelent
 Hemorrahgic
 Caseous
 50-200ml exudate
 Etiology unknown
 Scant acute and ch
inflammatory
infiltrate
 Fluid reabsorb leaving
any residual change
 Most commonly seen
in MI
 Associated with
friction rub
 Fibrin strands
 Inflammatory exudate
 Congested capillaries
 Exudate can
completely resolve or
can organize leaving
d...
 Usually signifies
bacterial, fungal or
parasitic infection
 Direct extension,
hematogenous or
lymphatic spread.
 Commo...
 400- 500 ml
 Thin to creamy pus
 Erythematous,
granular surface
 Can produce
constrictive
pericarditis
 Exudate of blood
admixed with
fibrinous to
supparative effusion
 Most commonly it
follows cardiac
surgery or associated...
 Due to tuberculosis
 Typically by direct
extension from
neighboring lymph
nodes or less
commonly mycotic
infection
 Le...
 Central caseous
necrosis
 Epitheliod histiocytes
forming granulomas
 Giant cells.
 Healing of acute lesions
 Adhesive medistinopericarditis
 Constrictive pericarditis
 Clinically significant
 Pericardial sac obliterated
 Parietal layer is tethered to medistinal tissue
 Heart so contra...
 Clinically significant
 Thick dense fibrous obliteration with
calcification of the pericardial sac encasing the
heart l...
 Normal in
patients with
acute pericarditis
unless
pericardial
effusion is
present
 Requires 200cc of
fluid
 the historic yield of diagnostic evaluation is
low, typically only in 16% of patients is
etiology determined.
 evaluati...
1) Chest pain
 Sudden onset
 localized to anterior chest wall
 pleuritic
 sharp
 Positional: may improve if pt leans ...
 Elevated C reactive protein level
 strong correlation - normal CRP makes acute
pericarditis diagnosis less likely
 Ele...
 51yo man with acute onset sharp substernal chest pain
two days prior
 Low voltage and Electric Alternans
 Pressure in pericardium exceeds pressure in
the cardiac chambers, lower chamber atria
affected before higher pressure ve...
 www.bidmc.org
 www.heartydog.co.uk
 www.budjzdorov.org.ua
 www.histopathology-india.net
Pericardial diseases
Pericardial diseases
Pericardial diseases
Pericardial diseases
Pericardial diseases
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Pericardial diseases

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Pericardial diseases

  1. 1. 1) Anatomy of pericardium 2) Overview of pericardial disease 3) Clinical presentation 4) Acute pericarditis 5) Chronic pericarditis
  2. 2.  Normal amount of pericardial fluid: 15-50 cc  Two layers:  Outer layer is the parietal pericardium and consists of layers of fibrous and serous tissue  Inner layer is visceral pericardium and consists of serous tissue only
  3. 3.  Fibroelastic sac consisting of 2 layers  Visceral at epicardial side  Parietal at mediastinal side  Pericardial fluid formed from ultrafiltrate of plasma
  4. 4.  Acute Pericarditis  Chronis pericarditis  Pericardial Effusion
  5. 5. 1)Infection 2)Radiation 3)Neoplasm 4)Myocardial intrinisic disease 5)Trauma 6)Autoimmune 7)Drugs 8)Metabolic *viral, autoreactive/autoimmune, and neoplastic most common diagnosis
  6. 6. Viral -adenovirus -enterovirus -cytomegalovirus -influenza -hepatitis B -herpes simplex -echovirus -mumps Mycoplasma Fungal Parasitic Bacterial -staphylococcus -streptococcus -pneumococcus -haemophilus -neisseria -chlamydia -legionella -tuberculous -lyme disease
  7. 7. Radiation Neoplasm -metastatic -primary cardiac -paraneoplastic Cardiac -early infarction -Dressler’s -myocarditis -aortic dissection Trauma -blunt -iatrogenic (perforations, post- surg) Autoimmune -rheumatic disease -non-rheumatic -Wegners, sarcoid, IBD
  8. 8. Drugs -drug induced lupus hydralazine isoniazid procainamide -doxorubicin -phenytoin Metabolic -hypothyroid -uremia -ovarian hyperstimulation
  9. 9.  Serous  Fibrinous  Purelent  Hemorrahgic  Caseous
  10. 10.  50-200ml exudate  Etiology unknown
  11. 11.  Scant acute and ch inflammatory infiltrate  Fluid reabsorb leaving any residual change
  12. 12.  Most commonly seen in MI  Associated with friction rub
  13. 13.  Fibrin strands  Inflammatory exudate  Congested capillaries  Exudate can completely resolve or can organize leaving delicate, stringy adhesions or plaque like thickening.
  14. 14.  Usually signifies bacterial, fungal or parasitic infection  Direct extension, hematogenous or lymphatic spread.  Common organisms streptococci, staphylococci and pneumococci
  15. 15.  400- 500 ml  Thin to creamy pus  Erythematous, granular surface  Can produce constrictive pericarditis
  16. 16.  Exudate of blood admixed with fibrinous to supparative effusion  Most commonly it follows cardiac surgery or associated with tuberculosis or malignancy  It organize with or without calcification
  17. 17.  Due to tuberculosis  Typically by direct extension from neighboring lymph nodes or less commonly mycotic infection  Lead to fibro calcific constrictive pericarditis.
  18. 18.  Central caseous necrosis  Epitheliod histiocytes forming granulomas  Giant cells.
  19. 19.  Healing of acute lesions  Adhesive medistinopericarditis  Constrictive pericarditis
  20. 20.  Clinically significant  Pericardial sac obliterated  Parietal layer is tethered to medistinal tissue  Heart so contract against the surrounding attached structures with hypertrophy and dilatation.
  21. 21.  Clinically significant  Thick dense fibrous obliteration with calcification of the pericardial sac encasing the heart limiting diastolic expansion and restricting cardiac output.
  22. 22.  Normal in patients with acute pericarditis unless pericardial effusion is present  Requires 200cc of fluid
  23. 23.  the historic yield of diagnostic evaluation is low, typically only in 16% of patients is etiology determined.  evaluation of pericardial fluid and tissue with tumor markers, PCR, immunohistochemistry, flourescence-activated cell sorting has shown a trend toward higher yield of diagnosis
  24. 24. 1) Chest pain  Sudden onset  localized to anterior chest wall  pleuritic  sharp  Positional: may improve if pt leans forward, worse with lying flat 2) Cardiac auscultation: Pericardial friction rub  Present in up to 85% of pts with pericarditis without effusion  friction of the two inflamed layers of pericardium, typically triphasic rub, heard with diaphragm of stethoscope at left sternal border 3) Characteristic ECG changes 4) Pericardial effusion
  25. 25.  Elevated C reactive protein level  strong correlation - normal CRP makes acute pericarditis diagnosis less likely  Elevated CK, CK-MB, and Troponin  Often elevated Troponin alone  Indicates inflammation of myocardium just beneath the visceral pericardium  Not associated with worse outcomes  Leukocytosis
  26. 26.  51yo man with acute onset sharp substernal chest pain two days prior
  27. 27.  Low voltage and Electric Alternans
  28. 28.  Pressure in pericardium exceeds pressure in the cardiac chambers, lower chamber atria affected before higher pressure ventricles  Compressive effect is seen best in the phase when the intrachamber pressure is lowest – systole for atria and diastole for ventricles  Diagnostic techniques  2D looking for RA/RV collapse during diastole  M-mode for RA/RV collapse during diastole  Doppler of Mitral and Tricuspid inflow  Mitral inflow to decrease by 25% with inspiration  Tricuspid inflow increased by 40% with inspiration  IVC diameter fails to increase with inspiration
  29. 29.  www.bidmc.org  www.heartydog.co.uk  www.budjzdorov.org.ua  www.histopathology-india.net
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