PERICARDIAL DISEASES- AFIQ

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PERICARDIAL DISEASES:

PERICARDIAL DISEASES BY MOHAMMAD AFIQ BIN ABD LATIF

ACUTE PERICARDITIS:

ACUTE PERICARDITIS

Slide 3:

This is inflammation of the pericardium May be idiopathic @ secondary to: Viruses ( coxsackie,flu,epstein-barr,mumps ) Bacteria ( pneumonia,rheumatic fever,TB,staph,streps ) Fungi MI Drugs ( penicillin,isoniazid,hydralazine,anti-neoplastic agents) Others ( uraemia,RA,SLE,myxoedema,malignancy,sarcoidosis )

Clinical Features:

Clinical Features Chest pain Central Worse on inspiration @ lying flat Relief wif sitting forward. Pericardial friction rub Sign of pericardial effusion n cardiac temponade . Fever maybe.

I(X):

I(X) ECG Saddle shaped ST segment elevation but mybe normal also. Blood FBC, ESR, U&E Cardiac enzyme ( troponin may elevated) Blood culture, check autoantibodies , viral serology, thyroid fx test. CXR ( cardiomegaly =pericardial effusion) ECHO (pericardial effusion)

T(X):

T(X) Analgesia (ibuprofen) Colchicine /steroid (but increase risk recurrence)/ immunosuppresant .

PERICARDIAL EFFUSION:

PERICARDIAL EFFUSION

CF:

CF Consider cx of pericarditis Dyspnoe Raised JVP Bronchial sound at lef lower lobe + sign cardiac temponade

Diagnosis n I(X):

Diagnosis n I(X) CXR ( cardiomegaly ) ECG ( small@low QRS cmplex n sometimes abnormal shaped) ECHO (show an echo-free zone surrounding heart)

M(X):

M(X) Treat cause Pericardiocentesis (diagnostic for bacterial pericarditis @ therapeutic for cardiac temponade ) Pecardial fluid (culture, ZN stain/TB culture,cytology )

Constrictive Pericarditis:

Constrictive Pericarditis

Slide 12:

Meaning the heart is encased in a rigid pericardium Cause is unknown but can be TB @ after any pericarditis

CF:

CF Sign of RHF Raised JVP Kaussmaul sign (JVP increase wif inspiration) Quite heart sound Hepatosplenomegaly Ascites n oedema

I(X):

I(X) CXR (small heart) CT n MRI (see pericardial calcification) ECHO M(X) = surgical incision!!

Cardiac Temponade:

Cardiac Temponade

Slide 16:

Meaning = accmltn of pericardial fluid raised intra-pericardial P, so poor vntrclr filling, hence reduce CO.. Causes include Any pericarditis Aortic dissection Haemodylisis Warfarin Post cardiac biopsy Post cardiac cathetherization

Sign:

Sign Tachycardia Drop BP Pulsus paradoxus JVP raised Kausmaul’s sign Muffled S1 n S2

Diagnosis n I(X):

Diagnosis n I(X) Beck’s triad (fall BP, raised JVP, small n quiet heart) CXR= can be cardiomegaly (if >250mL fluid) ECG = low @ small QRS cmplx ECHO ( nmpk pericardial effusion, diastolic collapse of R atrium n R vntrcl )

M(X):

M(X) Drainage n culture

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