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![TREATMENT
ADMISSION
â–Ş Subacute symptoms (eg, developing over several days or weeks).
â–Ş High fever (>38ÂşC [100.4ÂşF]) and leukocytosis.
â–Ş Evidence suggesting cardiac tamponade.
â–Ş A large pericardial effusion.
â–Ş Immunosuppressed state.
â–Ş A history of oral anticoagulant therapy.
â–Ş Acute trauma.
â–Ş Failure to respond within seven days to NSAID therapy, a generous allocation
of time.
â–Ş Elevated cardiac troponin, suggestive of myopericarditis.](https://image.slidesharecdn.com/pericarditis-171115185147/85/Pericarditis-23-320.jpg)
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Pericarditis
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- 2. OBJECTIVES â–Ş To definePericardium and Pericarditis. â–Ş To know causes and classification. â–Ş To diagnose Pericarditis well. â–Ş To pick up from other chest pain. â–Ş To know complecations. â–Ş To know proper treatment.
- 3. Pericardium A FIBROELASTIC SACCOMPOSED 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 INFLAMMATIONOF 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
- 5. CAUSES â–Ş Acute myocardialInfarction â–Ş Infection â–Ş Immunological reaction â–Ş Trauma â–Ş Neoplasm â–Ş Medications â–Ş Metabolic â–Ş Idiopathic
- 6. CAUSES â–Ş Acute myocardialInfarction (Early infarction pericarditis or Late postcardiac injury syndrome (Dressler's syndrome)) â–Ş Infection (Viral, Bacterial, Tubercular) â–Ş Immunological reaction (Lupus, Rheumatoid arthritis, Vasculitis, Scleroderma) â–Ş Trauma (Blunt, Penetrating) â–Ş Neoplasm â–Ş Medications (Procainamide, Isoniazid, Hydralazine, Phenytoin) â–Ş Metabolic (Hypothyroidism, Uremia) â–Ş Idiopathic
- 7. classification Acute Subacute Chronic <6 week 6 weeks – 6 months > 6 months Effusive Effusive-constrictive Effusive Fibrinous Constrictive Adhesive Constrictive
- 8. classification â–Ş serous â–Ş purulent â–Şfibrinous â–Ş caseous â–Ş hemorrhagic
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- 10. DIAGNOSIS AT LEAST 2CRITERIA OF 4 SHOULD BE PRESENT. • TYPICAL CHEST PAIN. • PERICARDIAL FRICTION RUB. • SUGGESTIVE ECG CHANGES. • NEW OR WORSENING PERICARDIAL EFFUSION
- 11. DIAGNOSIS CHEST PAIN • SUDDENIN 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.
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- 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 .
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- 19. DIAGNOSIS • CBC –VERY HIGH WBC (PURULENT PERICARDITIS) • CARDIAC ENZYMES ( TROPONIN , CK-MB) • ↑ESR • ↑CRP • TUBERCULIN SKIN TEST • HIV IN SELECTED CASES • ANA • RHEUMATOID FACTOR • BLOOD CULTURES IF FEBRILE • VIRAL CULTURES AND ANTIBODY TESTING NOT INDICATED
- 20. DIAGNOSIS ECHOCARDIOGRAM • NORMAL UNLESSTHERE IS AN EFFUSION. • PRESENCE OF EFFUSION SUPPORTS THE DIAGNOSIS, BUT ABSENCE DOES NOT EXCLUDE IT.
- 21. DIFFERENTIAL DIAGNOSIS Clinical â–Ş MyocardialInfarction â–Ş Aortic dissection â–Ş Pulmonary embolism â–Ş Myocarditis â–Ş Pneumothorax â–Ş Musculoskeletal EKG (ST elev) â–Ş AMI â–Ş Early Repolarization â–Ş Myocarditis â–Ş Hyperkalemia â–Ş Ventricular Aneurysm â–Ş Normal Variant
- 22. COMPLECATION • PERICARDIAL EFFUSION& CARDIAC TAMPONADE ( ACUTE OR SUBACUTE). • CONSTRICTIVE PERICARDITIS. • RELAPSINIG PERICARDITIS.
- 23. TREATMENT ADMISSION â–Ş Subacute symptoms(eg, developing over several days or weeks). â–Ş High fever (>38ÂşC [100.4ÂşF]) and leukocytosis. â–Ş Evidence suggesting cardiac tamponade. â–Ş A large pericardial effusion. â–Ş Immunosuppressed state. â–Ş A history of oral anticoagulant therapy. â–Ş Acute trauma. â–Ş Failure to respond within seven days to NSAID therapy, a generous allocation of time. â–Ş Elevated cardiac troponin, suggestive of myopericarditis.
- 24. TREATMENT • Goals ofacute 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 â–Ş Viral oridiopathic 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. â–Ş Pericardiocentesis to treat pericardial effusion/tamponade. â–Ş Antibiotics to treat tuberculosis or other bacterial causes. â–Ş Steroids are used in acute pericarditis connective tissue disease, autoreactive (immune-mediated) pericarditis or Uremic pericarditis.
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- 27. SUMMARY â–Ş Define Pericarditis. â–ŞMention suspected Causes. â–Ş How to Diagnose Pericarditis. â–Ş Differentiate between Pericarditis and AMI. â–Ş Suspected Complecations. â–Ş Proper Treatment.
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