2. OBJECTIVES
▪ To define Pericardium and Pericarditis.
▪ To know causes and classification.
▪ To diagnose Pericarditis well.
▪ To pick up from other chest pain.
▪ To know complecations.
▪ To know proper treatment.
3. Pericardium
A FIBROELASTIC SAC COMPOSED OF VISCERAL AND PARIETAL LAYERS .
IT NORMALLY FUNCTIONS TO PROTECT THE HEART AND REDUCE
FRICTION BETWEEN THE HEART AND SURROUNDING ORGANS.
BOTH THESE LAYERS ARE SEPARATED BY A PERICARDIAL CAVITY.
THE CAVITY NORMALLY CONTAINS 15 TO 50 ML OF STRAW-COLORED
FLUID.
4. Pericarditis
• IS INFLAMMATION OF THE PERICARDIUM
• IS THE MOST COMMON DISORDER INVOLVING THE PERICARDIUM
• 3 PER 10,000 PER YEAR
• MORE COMMON IN MEN
• OCCURS BETWEEN THE AGES OF 20 TO 50 YEARS
10. DIAGNOSIS
AT LEAST 2 CRITERIA OF 4 SHOULD BE PRESENT.
• TYPICAL CHEST PAIN.
• PERICARDIAL FRICTION RUB.
• SUGGESTIVE ECG CHANGES.
• NEW OR WORSENING PERICARDIAL EFFUSION
11. DIAGNOSIS
CHEST PAIN
• SUDDEN IN ONSET
• RETROSTERNAL IN LOCATION
• PLEURITIC AND SHARP IN NATURE
• EXACERBATED BY INSPIRATION AND COUGHING
• WORSENS WHEN SUPINE AND IMPROVES UPON SITTING
UPRIGHT OR LEANING FORWARD.
• CAN OFTEN RADIATE TO THE NECK, ARMS, OR LEFT
SHOULDER, TRAPEZIUS MUSCLE.
13. DIAGNOSIS
PERICARDIAL FRICTION RUB
• PRESENT IN 85% OF CASES OF PERICARDITIS
• HIGHLY SPECIFIC WITH A VARIABLE SENSITIVITY
• A HIGH-PITCHED SCRATCHY OR SQUEAKY SOUND BEST
HEARD WITH THE DIAPHRAGM AT THE LT. STERNUM
BORDER WITH THE PATIENT LEANING FORWARD.
14. DIAGNOSIS
ECG
• STAGE 1 (1ST HRS-DYS) :CHARACTERIZED BY DIFFUSE ST
ELEVATION (TYPICALLY CONCAVE UP).
• STAGE 2(1ST WK) : CHARACTERIZED BY NORMALIZATION
OF THE ST & PR SEGMENTS.
• STAGE 3: DIFFUSE T WAVE INVERSIONS.
• STAGE 4 :NORMALIZATION OF THE ECG OR INDEFINITE
PERSISTENCE OF T WAVE INVERSIONS.
TYPICAL ECG EVOLUTION IN AP HAS BEEN SHOWN IN UP TO 60% OF PTS IN A
CLINICAL SERIES IN STAGE 1 .
23. TREATMENT
ADMISSION
▪ Subacute symptoms (eg, developing over several days or weeks).
▪ High fever (>38ºC [100.4ºF]) and leukocytosis.
▪ Evidence suggesting cardiac tamponade.
▪ A large pericardial effusion.
▪ Immunosuppressed state.
▪ A history of oral anticoagulant therapy.
▪ Acute trauma.
▪ Failure to respond within seven days to NSAID therapy, a generous allocation
of time.
▪ Elevated cardiac troponin, suggestive of myopericarditis.
24. TREATMENT
• Goals of acute therapy:
a. Relieve Pain
b. Treat the inflammation
c. Prevent Cardiac tamponade and Constrictive pericarditis .
• Most viral infections are self-limited
• Treat the underlying disease process
• Drain purulent effusions
• Symptomatic therapy
25. TREATMENT
▪ Viral or idiopathic pericarditis is with aspirin, or non-steroidal anti-
inflammatory drugs (NSAIDs such as ibuprofen) + Colchicine may
be it decreases the risk of further episodes of pericarditis.
▪ Pericardiocentesis to treat pericardial effusion/tamponade.
▪ Antibiotics to treat tuberculosis or other bacterial causes.
▪ Steroids are used in acute pericarditis connective tissue disease,
autoreactive (immune-mediated) pericarditis or Uremic
pericarditis.
