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Acute pericarditis

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acute pericarditis full medicine

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Acute pericarditis

  1. 1. Acute pericarditis
  2. 2. • The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity.
  3. 3. • In healthy individuals, the pericardial cavity contains 15 to 50 mL of an ultrafiltrate of plasma
  4. 4. Diseases of the pericardium present clinically in one of four ways • Acute pericarditis • Pericardial effusion without major hemodynamic compromise • Cardiac tamponade • Constrictive pericarditis
  5. 5. • Acute pericarditis is the most common disorder involving the pericardium
  6. 6. Major causes of acute pericarditis • Infections • Cardiac • Autoimmune • Metabolic
  7. 7. • Neoplasm • Drugs • Trauma • Idiopathic
  8. 8. Infections • Viral - Coxsackievirus, echovirus, adenovirus, EBV, CMV, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19, vaccina (smallpox vaccination)
  9. 9. • Bacterial - Staphylococcus, Streptococcus, pneumococcus, Haemophilus, Neisseria (gonorrhoeae or meningitidis), Chlamydia (psittaci or trachomatis), Legionella, tuberculosis, Salmonella, Lyme disease
  10. 10. • Mycoplasma
  11. 11. • Fungal - Histoplasmosis, aspergillosis, blastomycosis, coccidiodomycosis, actinomycosis, nocardia, candida
  12. 12. • Parasitic - Echinococcus, amebiasis, toxoplasmosis
  13. 13. Cardiac • Early infarction pericarditis • Late postcardiac injury syndrome (Dressler's syndrome), also seen in other settings (eg, post-myocardial infarction and post-cardiac surgery)
  14. 14. Autoimmune • Rheumatic diseases - Including lupus, rheumatoid arthritis, vasculitis, scleroderma, mixed connective disease
  15. 15. • Other - Granulomatosis with polyangiitis (Wegener's), polyarteritis nodosa, sarcoidosis, inflammatory bowel disease (Crohn's, ulcerative colitis), Whipple's, giant cell arteritis, Behcet's disease, rheumatic fever
  16. 16. Metabolic • Hypothyroidism - Primarily pericardial effusion • Uremia • Ovarian hyperstimulation syndrome
  17. 17. Neoplasm • Metastatic - Lung or breast cancer, Hodgkin's disease, leukemia, melanoma • Primary - Rhabdomyosarcoma, teratoma, fibroma, lipoma, leiomyoma, angioma • Paraneoplastic
  18. 18. Drugs • Procainamide, isoniazid, or hydralazine as part of drug-induced lupus • Other - Cromolyn sodium, dantrolene, methysergide, anticoagulants, thrombolytics, phenytoin, penicillin, phenylbutazone, doxorubicin
  19. 19. Trauma • Blunt • Penetrating
  20. 20. Idiopathic • In most case series, the majority of patients are not found to have an identifiable cause of pericardial disease. • Frequently such cases are presumed to have a viral or autoimmune etiology
  21. 21. Clinical manifestations • The major clinical manifestations of acute pericarditis include :
  22. 22. • Chest pain – typically sharp and pleuritic, improved by sitting up and leaning forward
  23. 23. • Pericardial friction rub – a superficial scratchy or squeaking sound best heard with the diaphragm of the stethoscope over the left sternal border
  24. 24. • Electrocardiogram (ECG) changes – new widespread concave ST segment elevation • In STEM convex ST segment elevation
  25. 25. • The ST segment is usually isoelectric (ie, zero potential as identified by the T-P segment) and has a slight upward concavity.
  26. 26. Acute pericarditis : widespread concave ST elevation
  27. 27. The typical progression of ECG changes in patients with acute pericarditis
  28. 28. • Pericardial effusion------------ tampnade
  29. 29. PROGNOSIS • Patients with acute idiopathic or viral pericarditis have a good long-term prognosis.
  30. 30. • Cardiac tamponade rarely occurs in patients with acute idiopathic pericarditis and is more common in patients with a specific underlying etiology such as malignancy, tuberculosis, or purulent pericarditis.
  31. 31. • Constrictive pericarditis may occur in about 1 percent of patients with acute idiopathic pericarditis, and is also more common in patients with a specific etiology.
  32. 32. Treatment • The therapy of acute pericarditis should be targeted as much as possible to the underlying etiology
  33. 33. • Most patients are treated for a presumptive viral cause with nonsteroidal anti-inflammatory drugs (NSAIDS) and colchicine
  34. 34. • Most patients with acute pericarditis can be managed effectively with medical therapy alone.
  35. 35. • However, patients with a large pericardial effusion, a hemodynamically significant pericardial effusion, a suspicion of a bacterial or neoplastic etiology, or evidence of constrictive pericarditis should be evaluated for invasive therapies, such as pericardial drainage and/or pericardiotomy.

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