Clinical management final exam
Serious pericarditis Identifiers - smooth surface,
scant neutrophils,
lymphocytes and macrophages,
usually with effusion of 50-200mL of thin fluid (protein <50% of serum level
Pergola pericarditis Identifiers - red granular surface coated with pus,
-up to 500mL of exudate in pericardium
lost of subsurface neutrophils,
Fibrinous pericarditis Identifiers - "bread and butter" surface,
more neutrophils, lymphocytes and macrophages,
dry, roughened, shappy,
serofibrinous if with effusion
Hemorrhagic pericarditis Identifiers - serous, fibrinous or purulentpus hemorrhage, +/- effusion or
exudate with blood added
-rare
Additional testing for hemorrhagc pericarditis - Associated with
-metastatic CA,
-leukemia,
-thrombocytopenia,
-TB
,-skin test for TB (PPD) and CXR for unexplained pericarditis
Etiology of Pericarditis Infective - Infective
-Viral
--Idiopathic, self-limiting, not cultured
-Bacterial
--High mortality rate
--staph aureus, strep. pneumoniae
-Fungus
-Parasite
Etiology of Pericarditis Nonaffective - Post MI
-extension of visceral pericarditis to parietal over large transmural infarct; uncommon
-Dressler syndrome: 2-12wks after infarct; probably autoimmune, has become rare
Auto immune diseases
Medication's
Radiation
Renal failure
Trauma
Common auto immune disorders with pericarditis - Lupus
-30% of patients with lupus develop pericarditis
Rheumatoid arthritis
,Medication is the cause nonaffective pericarditis - Procainamide
Hydralazine
presentation of pericarditis - Recurrent chest pain
-Sharp
-Pleuritic
--increased with inspiration
-Positional
--Increases with supine
Heart palpitations
Pericardial effusion
Pericardial effusion def - a collection of fluid between the pericardial sac and the myocardium
Physical presentation of pericarditis - Fever
Shortness of breath
malaise,
myalgias (muscle aches)
-viral
pericardial friction rub: evanescent, superficial, scratchy, to and fro,
Best to hear pericardial friction rub With pericarditis - best heard with diaphragm, w/ pt leaning forward
and exhaling
-evanescent, superficial, scratchy, to and fro,
EKG changes with pericarditis - DIFFUSE ST elevations without reciprocal changes,
, PR DEPRESSION
Echocardiogram findings when pericarditis is suspected - Pericardial if fusion
Cardiac Tamponade
Grading of pericardial effusion - Small less than 10 mm
Moderate 10 to 20 mm
Severe greater than 20 mm
Diagnostic criteria for Pericarditis - 2 of 4 needed:
-typical pericarditis chest pain
-pericardial friction rub
--(have pt lean forward)
-widespread ST-segment elevation
-pericardial effusion
Test to run when pericarditis is suspected - physical exam,
ECG,
echo,
CXR
-enlarged heart with pericardial effusion, "bottle shape" silhouette
Chest x-ray with pericarditis - enlarged heart with pericardial effusion, "bottle shape" silhouette
Serious pericarditis Identifiers - smooth surface,
scant neutrophils,
lymphocytes and macrophages,
usually with effusion of 50-200mL of thin fluid (protein <50% of serum level
Pergola pericarditis Identifiers - red granular surface coated with pus,
-up to 500mL of exudate in pericardium
lost of subsurface neutrophils,
Fibrinous pericarditis Identifiers - "bread and butter" surface,
more neutrophils, lymphocytes and macrophages,
dry, roughened, shappy,
serofibrinous if with effusion
Hemorrhagic pericarditis Identifiers - serous, fibrinous or purulentpus hemorrhage, +/- effusion or
exudate with blood added
-rare
Additional testing for hemorrhagc pericarditis - Associated with
-metastatic CA,
-leukemia,
-thrombocytopenia,
-TB
,-skin test for TB (PPD) and CXR for unexplained pericarditis
Etiology of Pericarditis Infective - Infective
-Viral
--Idiopathic, self-limiting, not cultured
-Bacterial
--High mortality rate
--staph aureus, strep. pneumoniae
-Fungus
-Parasite
Etiology of Pericarditis Nonaffective - Post MI
-extension of visceral pericarditis to parietal over large transmural infarct; uncommon
-Dressler syndrome: 2-12wks after infarct; probably autoimmune, has become rare
Auto immune diseases
Medication's
Radiation
Renal failure
Trauma
Common auto immune disorders with pericarditis - Lupus
-30% of patients with lupus develop pericarditis
Rheumatoid arthritis
,Medication is the cause nonaffective pericarditis - Procainamide
Hydralazine
presentation of pericarditis - Recurrent chest pain
-Sharp
-Pleuritic
--increased with inspiration
-Positional
--Increases with supine
Heart palpitations
Pericardial effusion
Pericardial effusion def - a collection of fluid between the pericardial sac and the myocardium
Physical presentation of pericarditis - Fever
Shortness of breath
malaise,
myalgias (muscle aches)
-viral
pericardial friction rub: evanescent, superficial, scratchy, to and fro,
Best to hear pericardial friction rub With pericarditis - best heard with diaphragm, w/ pt leaning forward
and exhaling
-evanescent, superficial, scratchy, to and fro,
EKG changes with pericarditis - DIFFUSE ST elevations without reciprocal changes,
, PR DEPRESSION
Echocardiogram findings when pericarditis is suspected - Pericardial if fusion
Cardiac Tamponade
Grading of pericardial effusion - Small less than 10 mm
Moderate 10 to 20 mm
Severe greater than 20 mm
Diagnostic criteria for Pericarditis - 2 of 4 needed:
-typical pericarditis chest pain
-pericardial friction rub
--(have pt lean forward)
-widespread ST-segment elevation
-pericardial effusion
Test to run when pericarditis is suspected - physical exam,
ECG,
echo,
CXR
-enlarged heart with pericardial effusion, "bottle shape" silhouette
Chest x-ray with pericarditis - enlarged heart with pericardial effusion, "bottle shape" silhouette
