m orning r eport friday september 3, 2010. p ericardium encloses heart ascending aorta pulmonary...

MORNING REPORTFriday September 3, 2010

PERICARDIUM

Encloses Heart Ascending aorta Pulmonary trunk Terminal segment of

the vena cavae Serous vs Parietal Fluid

Ultrafiltrate of plasma

PERICARDITIS

Infectious Autoimmune

Rheumatic fever Uremia Malignancy Drug reaction Post Surgical Idiopathic

VIRAL CAUSES

10 to 14 day prodromal illness

Respiratory or GI

Coxsackie Echo Adeno Epstein-Barr Influenza HIV

BACTERIAL CAUSES

Higher mortality Toxic

Higher fever Irritability

Cardiomegaly on CXR Spread from surgery or

infection Staph and H.flu

TB in immunocompromised

SIGNS AND SYMPTOMS

Chest pain Substernal, sharp, worse with inspiration,

relieved by sitting upright and leaning forward Radiation to scapular ridge

Friction rub Scratchy, high-pitched, to-and-fro

LABS

Elevation WBC ESR CRP Troponin

Myocardial involvement Specific Cause

Blood culture, viral culture, TB, RF, ANA

ECG

ECG

Stage 2 Normalization of the ST and PR segments

Stage 3 Development of widespread T-wave inversions

Step 4 Normalization of the T waves

PERICARDIAL EFFUSION

CXR “water-bottle heart”

Echo Support the diagnosis

MANAGMENT

Treat the underlying cause Alleviate pain and inflammation

NSAIDs Colchicine if recurrent or chronic (>2 weeks)

What about steroids? Controversial

Avoid Diuretics Avoid Intubation

COMPLICATIONS Recurrence

1/3 Constrictive pericarditis Cardiac tamponade

Tachycardia, hypotension, increased JVP, muffled heart sounds, hepatomegaly, narrow pulse pressure

Pulsus paradoxusElectrical alternans

STICK A NEEDLE IN IT!

Pericardiocentesis Hemodynamic compromise Cardiac tamponade Purulent pericarditis Neoplastic pericarditis

Pericardial window or pericardiectomy Resistant cases