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Pericardial disease Undergaraduate
The document discusses the pericardium, a double-layered sac that protects the heart, its functions, and various pericardial diseases such as acute and chronic pericarditis. It describes clinical features, diagnostic methods, and treatment options including medications like aspirin and glucocorticoids, as well as pericardiocentesis for cardiac tamponade. The document also highlights the importance of recognizing cardiac tamponade in clinical settings due to its variable presentations.
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Pericardial disease Undergaraduate
- 1. Dr(Lt Col) AshutoshOjha Reader Internal Medicine Pericardial Diseases
- 2. Pericardium -Intro Pericardiumis a double-layered sac; Visceral pericardium is a serous membrane that is separated by a small quantity (15–50 mL) of fluid, Pericardial Fluid- ultrafiltrate of plasma, secreted from the parietal pericardium.
- 3. Pericardium -Function Preventssudden dilation of the cardiac chambers Restricts the anatomic position of the heart Minimizes friction between the heart and surrounding structures Prevents displacement of the heart and kinking of the great vessels, and Probably retards the spread of infections from the lungs and pleural cavities to the heart. Nevertheless, total absence of the pericardium, either congenital or after surgery, does not produce obvious clinical disease.
- 4. Diseases Acute Pericarditis Cardiac Tamponade Chronic Pericarditis Pericardial Neoplasm
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- 7. Etiologic Classification Harrisons Principles of Internal Medicine-19th Edn Pericarditis presumably related to hypersensitivity or autoimmunity A. Rheumatic fever B. Collagen vascular disease (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, acute rheumatic fever, granulomatosis with polyangiitis (Wegener's) C. Drug-induced (e.g., procainamide, hydralazine, phenytoin, isoniazide, minoxidil, anticoagulants, methysergide) D. Post-cardiac injury 1. Postmyocardial infarction (Dressler's syndrome) 2. Postpericardiotomy 3. Posttraumatic
- 8. Acute pericarditis –Clinical features most common pathologic process involving the pericardium Chest pain pericardial friction rub electrocardiogram (ECG)
- 9. Acute pericarditis –ECGfeatures Stage 1 Widespread elevation of the ST segments, with upward concavity, involving two or three standard limb leads and V2 to V6, with reciprocal depressions only in aVR and sometimes V1, Depression of the PR segment below the TP segment reflecting atrial involvement. No significant changes in QRS complexes. In Stage 2, after several days, the ST segments return to normal, Stage 3- Do the T waves become inverted ECG returns to normal in Stage 4
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- 12. Other Bedside Inv Echocardiography is the most widely used imaging technique since it is sensitive, specific, simple, and noninvasive; may be performed at the bedside; and can identify accompanying cardiac tamponade .
- 13. Cardiac Tamponade Theaccumulation of fluid in the pericardial space in a quantity sufficient to cause serious obstruction to the inflow of blood to the ventricles .
- 14. Cardiac Tamponade-Cl features Hypotension, Soft or absent heart sounds, Jugular venous distention with a prominent x descent but an absent y descent. Pulsus paradoxus The quantity of fluid necessary to produce this critical state may be as small as 200 mL when the fluid develops rapidly or >2000 mL in slowly developing effusions when the pericardium has had the opportunity to stretch and adapt to an increasing volume
- 15. Difficult to diagnose A high index of suspicion for cardiac tamponade is required since in many instances no obvious cause for pericardial disease is apparent, and it should be considered in any patient with otherwise unexplained enlargement of the cardiac silhouette, hypotension, and elevation of jugular venous pressure. There may be reduction in amplitude of the QRS complexes, and electrical alternans of the P, QRS, or T waves should raise the suspicion of cardiac tamponade.
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- 18. Further work up Pericardial fluid analysis ADA Malignant Cells
- 19. Viral or IdiopathicForm of Acute Pericarditis CMV ,EBV Short benign course <4 wks Chest pain Tamponade rarely Extremes of Age
- 20. Acute Pericarditis-Rx Nospecific therapy, Bed rest Anti-inflammatory treatment with aspirin (2–4 g/d) may be given. Glucocorticoids (e.g., prednisone, 40–80 mg daily) usually suppress the clinical manifestations of the acute illness. After the patient has been asymptomatic and afebrile for about a week, the dose of the NSAID may be tapered gradually. Colchicine may prevent recurrences, Multiple recurrences are frequent, and disabling; continued beyond 2 years; and are not controlled by glucocorticoids, pericardiectomy may be necessary to terminate the illness
- 21. Postcardiac Injury Syndrome 1 to 4 week later May occur after 3months Result of a hypersensitivity reaction to antigen that originates from injured myocardial tissue and/or pericardium Rx-Asprin and glucocorticoids
- 22. Chronic pericarditis Tb Collagen vascular Neoplastic Ideopathic Mediterranian
- 23. Rx Approach theprimary cause Asprin Regular follow up Pericardiocentasis –as when required
- 24. Neoplasm Primary –mesotheliolma Secondary-mediastinum cancers, carcinoma of the bronchus and breast, lymphoma, melanoma
- 25. Pericardial cysts Rare Rounded or lobulated deformities of the cardiac silhouette, Most commonly at the right cardiophrenic angle. Asymptomatic, and their major clinical significance lies in the possibility of confusion with a tumor, ventricular aneurysm, or massive cardiomegaly
- 26. Tuberculous Pericarditis Developingcountries Fibrinous Chr sequale Diagnosis Clinical –Fluid analysis ATT- extended regime Pericardial stipping common
- 27. Uremic pericarditis Evenin stages -4 Florid Immediate tamponade Post dialysis also occurs Associated TB May require Surgery
- 28. My references HarrisonsPrinciples of Internal Medicine -18th Edn Chapters 239. Clinical Medicine –Kumar & Calrke 9th Edn
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- 30. Contact-9719713786 ashutosh8116@yahoo.com sumitranikentanpatna@gmail.com 17 Feb2016Dr A Ojha Available ….