Pericarditis: Difference between revisions
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==Background==
== Background ==
 


Causes:
Causes:
#idiopathic
#infectious, including AIDS related
#malignancy: heme, lung, breast
#uremia
#post radiation
#connective tissue dz
#drugs: procainamide, hydralaine, methyldopa, anticoagulants
#cardiac injury (can see up to weeks later): post MI, trauma, aortic dissection


- idiopathic
== Diagnosis ==
 
#usually sharp pleuritic chest pain, but can be anything
- infectious, including AIDS related
#radiates to chest, back, trapezius ridge
 
#diminish with sitting up/lean forward
- malignancy: heme, lung, breast
#SOB, esp if concommitant pleural effusion
 
#hypotension/extremis if tamponade
- uremia
 
- post radiation
 
- connective tissue dz
 
- drugs: procainamide, hydralaine, methyldopa, anticoagulants
 
- cardiac injury (can see up to weeks later): post MI, trauma, aortic dissection
 
 
==Diagnosis==
 
 
- usually sharp pleuritic chest pain, but can be anything
 
- radiates to chest, back, trapezius ridge
 
- diminish with sitting up/lean forward
 
- SOB, esp if concommitant pleural effusion
 
- hypotension/extremis if tamponade
 
== ==
 
 
==Workup==


== Workup ==


EKG is virtually diagnostic
EKG is virtually diagnostic
 
#less reliable in post MI patients and others with baseline EKG abnormalities
- less reliable in post MI patients and others with baseline EKG abnormalities
#if pt. has early repol.confounding interpretation, check (ST elev)/(T height) in V6; if >0.25 likely pericarditis
 
- if pt. has early repol.confounding interpretation, check (ST elev)/(T height) in V6; if >0.25 likely pericarditis
 


EKG progression:
EKG progression:
 
#global concave up ST elev, +/- PR depression
1) global concave up ST elev, +/- PR depression
#ST to baseline, big T's, PR dep
 
#T wave flatten then inversion
2) ST to baseline, big T's, PR dep
#return to baseline EKG
 
3) T wave flatten then inversion
 
4) return to baseline EKG
 


CXR, WBC, ESR, CK-MB, TN all nonspecific.
CXR, WBC, ESR, CK-MB, TN all nonspecific.


Echo will show NL wall motion
Echo will show NL wall motion
 
#also useful to monitor progress
  - also useful to monitor progress
 


Friction rub
Friction rub


== Differential Diagnosis ==
 
==Differential Diagnosis==
 


MI is the big confounder
MI is the big confounder


{| border="1"
{| border="1"
|-
| '''MI'''
| '''MI'''
| '''Pericarditis'''
| '''Pericarditis'''
|-
|-
| no fever
| no fever
|
|  
fever
fever


pain varries w/motion
pain varries w/motion
|-
|-
| focal ST chgs
| focal ST chgs
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CHF, PE, PTX, aortic dissection, pneumomediastinum, pleuritis
CHF, PE, PTX, aortic dissection, pneumomediastinum, pleuritis


==Treatment==
== Treatment ==
 
#Mostly supportive
#NSAIDS for viral/idiopathic
#Recurrent - colchicine
#Uremic - dialysis
#"buy time" with fluid boluses
#Tamponade --> pericardiocentesis


- Mostly supportive
(See Procedures: Pericardiocentesis)


- NSAIDS for viral/idiopathic
== Disposition ==
 
#Most need admission, but if young and healthy can echo, and D/C with close f/u
- Recurrent - colchicine
 
- Uremic - dialysis
 
-"buy time" with fluid boluses
 
- Tamponade --> pericardiocentesis
 
    (See Procedures: Pericardiocentesis)
 
 
==Disposition==
 
 
- Most need admission, but if young and healthy can echo, and D/C with close f/u
 


Risk Stratification
Risk Stratification


HIGH RISK (admit)
HIGH RISK (admit)
#Subacute sx (several dys-wks)
#Fever >100.4
#Evidence of tamponade
#Large effusion (>20mm)
#Immunosupressed
#On anticoagulant
#Acute trauma
#Failure to respond to NSAID Rx (>7dy)


1) Subacute sx (several dys-wks)
== Complications ==
 
2) Fever >100.4
 
3) Evidence of tamponade
 
4) Large effusion (>20mm)
 
5) Immunosupressed
 
6) On anticoagulant
 
7) Acute trauma
 
8) Failure to respond to NSAID Rx (>7dy)
 
 
==Complications==
 
 
Tamponade/Effusion-see Pericardial Effusion and Tamponade
 
 
Recurrence===
 
 
-usually weeks to months after initial episode
 
-management is same
 
 
Contrictive Pericarditis==
 
 
-restrictive picture with  pericardial calcific on CXR and thicken on ECHO
 
- Rx window
 
 
==Source==


Tamponade/Effusion-see Pericardial Effusion and Tamponade


Adapted from Pani, Donaldson, and UpToDate
===Recurrence===
#usually weeks to months after initial episode
#management is same


===Contrictive Pericarditis==
#restrictive picture with pericardial calcific on CXR and thicken on ECHO
#Rx window


== Source ==


Adapted from Pani, Donaldson, and UpToDate


[[Category:Cards]]
<br/>[[Category:Cards]]

Revision as of 07:01, 12 March 2011

Background

Causes:

  1. idiopathic
  2. infectious, including AIDS related
  3. malignancy: heme, lung, breast
  4. uremia
  5. post radiation
  6. connective tissue dz
  7. drugs: procainamide, hydralaine, methyldopa, anticoagulants
  8. cardiac injury (can see up to weeks later): post MI, trauma, aortic dissection

Diagnosis

  1. usually sharp pleuritic chest pain, but can be anything
  2. radiates to chest, back, trapezius ridge
  3. diminish with sitting up/lean forward
  4. SOB, esp if concommitant pleural effusion
  5. hypotension/extremis if tamponade

Workup

EKG is virtually diagnostic

  1. less reliable in post MI patients and others with baseline EKG abnormalities
  2. if pt. has early repol.confounding interpretation, check (ST elev)/(T height) in V6; if >0.25 likely pericarditis

EKG progression:

  1. global concave up ST elev, +/- PR depression
  2. ST to baseline, big T's, PR dep
  3. T wave flatten then inversion
  4. return to baseline EKG

CXR, WBC, ESR, CK-MB, TN all nonspecific.

Echo will show NL wall motion

  1. also useful to monitor progress

Friction rub

Differential Diagnosis

MI is the big confounder

MI Pericarditis
no fever

fever

pain varries w/motion

focal ST chgs diffuse ST elev
reciprocal chgs no reciprocal chgs
Q waves no Q wave
+/- pulm edema clear lungs
wall motion abn nl wall motion

also on DDx:

CHF, PE, PTX, aortic dissection, pneumomediastinum, pleuritis

Treatment

  1. Mostly supportive
  2. NSAIDS for viral/idiopathic
  3. Recurrent - colchicine
  4. Uremic - dialysis
  5. "buy time" with fluid boluses
  6. Tamponade --> pericardiocentesis

(See Procedures: Pericardiocentesis)

Disposition

  1. Most need admission, but if young and healthy can echo, and D/C with close f/u

Risk Stratification

HIGH RISK (admit)

  1. Subacute sx (several dys-wks)
  2. Fever >100.4
  3. Evidence of tamponade
  4. Large effusion (>20mm)
  5. Immunosupressed
  6. On anticoagulant
  7. Acute trauma
  8. Failure to respond to NSAID Rx (>7dy)

Complications

Tamponade/Effusion-see Pericardial Effusion and Tamponade

Recurrence

  1. usually weeks to months after initial episode
  2. management is same

=Contrictive Pericarditis

  1. restrictive picture with pericardial calcific on CXR and thicken on ECHO
  2. Rx window

Source

Adapted from Pani, Donaldson, and UpToDate


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