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Dresslers syndrome
occurs 2-3 weeks after MI or open heart surgery
Autoimmune component and possibly a latent viral infection
implicated
consists of pleuritic chest pain, fever, leukocytosis, and a
pericardial friction rub
Radiation Pericarditis
Trauma Pericarditis
Outcome
PERICARDIAL EFFUSION
Myocardial Infarction Definition
Essentials of Diagnosis
Treatment
Symptoms
Chest Radiography
Cardiomegaly occurs if there is more than 250 ml of fluid in the
pericardial sac
Diagnosis
Electrocardiography
Abnormal findings may include:
1. Electrical alternans - height of QRS varies like 3 mvolt, 5,8 millivolts.
Check the height of ECG.
It is commonly seen on pt with neck vein engorgement,
cardiomegalySUSPECT CARDIAC TAMPONADE
Massive pericardial effusion
you need at least 250 cc of pericardial fluid for you to
produce Cardiomegaly secondary to Pleural effusion,
Cardiothoracic ratio of >0.5 or something like 0.7
Typical water bottle configuration
2. Low voltage
3. Changes associated with acute pericarditis
Since there is a fluid in between the transmission of electrical potential
going to the ECG DOUBLE lean lead ecg? ??? ano d daw? Sorry ..
QRS is small
Lean? Leads- at least 5 millivolts( para hind maconsiderdouble...)
Chest lead- V1-V6- 5 millivolt;
Lead II and V -7 millivolts
Lead 3 and 4 9millivolts
IF hindi ganito yung value, we can consider na meron Double ...
Transthoracic Echocardiography
Sensitive finding for tamponade physiology is inferior vena
cava plethora, with absent inspiratory collapse
Pericardial Constriction/ Constrictive Pericarditis
Right ventricle and atrial collapse on echocardiography is the
most accurate finding for diagnosis Definition
ECHOCARDIOGRAPHY- confirms the dx of pericardial
effusion and cardiac tamponade and to the point that An abnormal thickening of the pericardium, resulting in impaired
effusion is called swimming heart ventricular filling and decreased cardiac output
Most cases idiopathic
Right Heart Catheterization May have history of acute or chronic pericarditis
Most typical finding: equalization of mean right atrial, right ventricular
and pulmonary artery diastolic, and mean pulmonary capillary wedge Essentials of Diagnosis
pressures. Markedly elevated JVP with accentuated x and y descent and
Kussmauls sign
Treatment Kussmauls sign- enlargement of neck vein during deep inspiration (
Medical emergency Normal:collapsed neck vein )
Remove the fluid Kussmaul's sign is a paradoxical rise in jugular venous
Immediate hospital admission and prompt pressure (JVP) on inspiration.
pericardial drainage by pericardiocentesis It can be seen in some forms of heart disease and is
If follow-up echocardiography documents fluid re-accumulation usually indicative of limited right ventricular filling due
pericardial window should be considered to right heart failure.
Infection risk associated with a pericardial drain increases after 48 hours Pericardial knock on auscultation
MRI, CT or echocardiographic imaging showing a thickened
Differential Diagnosis pericardium
1. Right-sided heart failure
2. Right ventricular infarction
3. Constrictive pericarditis Pathophysiology
4. Pulmonary embolism
Initiating event causes a chronic inflammatory pericardial process fibrinous
Treatment thickening & calcification of pericardium limitation of intrapericardial
Immediate hospital admission and prompt pericardial drainage by volume impaired ventricular filling decreased cardiac output right and
pericardiocentesis left ventricular failure
If follow-up echocardiography documents fluid re-accumulation
pericardial window should be considered
Infection risk associated with a pericardial drain increases after 48
hours
Physical Examination
Increased ventricular filling pressures cause:
1. Jugular vein distention
2. Kussmauls sign absent inspiratory decline of jugular venous distention
Auscultation: muffled heart sounds and occasionally a
characteristic pericardial knock (60-200 milliseconds after the
second heart sound)
Diagnosis
ECG
Non-specific but low voltage of QRS complex may be seen
Laboratory tests
Brain natriuretic peptide (BNP) serum biomarker; distinguish
constrictive from restrictive pericarditis higher in resetrictive
Echocardiography
Best imaging modality for assessing
hemodynamic parameters non-invasively
Doppler echocardiographic
findings have the highest sensitivity and specificity for detecting
constrictive physiology
MRI & CT
CT is the imaging modality of choice to evaluate the
pericardium
Pericardial calcifications may easily be identified on CT
Finding of thickened pericardium on the CT or MRI is specific
for constriction
Treatment
Medical treatment is difficult and does not affect the natural
progression or prognosis of the disease
Diuretics and a low-sodium diet for patients with mild to moderate
(New York Heart Association [NYHA] Class I or II) symptoms or
contraindications to surgery
For most patients, pericardiectomy is advised, with 80% to 90% of
patients experiencing improvement and 50% complete relief of
symptoms
remove the pericardium