PericardiaI Diseases Causes and Treatment —

• The heart is covered by two protective membranes­
• Parietal pericardium – Fibrous outer mem­brane.
• Visceral pericardium – Serous inner mem­brane.
• The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity.

The functions of the pericardium are:

• It prevents sudden dilatation and stretching It fixes the heart, and prevents displacement Minimizes flexion
• Prevents spread of infection.

Diseases of the pericardium present clinically in one of four ways:

• Acute fibrinous pericarditis
• Pericardial effusion without major hemodynamic compromise
• Cardiac tamponade
• Constrictive pericarditis

PericardiaI Diseases DIAGNOSTIC and CLINICAL PRESENTATION —

• ECG changes — new widespread ST elevation or PR depression
• Pericardial effusion
• Chest pain
• Pericardial friction rub

ACUTE PERICARDITIS

• Acute pericarditis is acute inflammation of the peri­cardium.
• Diagnosed by typical pericardial pain, pericardial fric­tion rub, ECG changes, pericardial effusion, cardiac tamponade and paradoxical pulse.

Chest pain of pericarditis

• Moderate or severe Retrosternal and left precordial
• May be a constricting pain or heaviness May be referred to back
• May be aggravated by coughing and deep inspi­ration
• May radiate to one or both arms
• Relieved by sitting up and leaning forwards Increased in the supine position.

Pericardial Friction Rub

• May be heard in different parts of the cardiac cycle
• It is heard mostly during expiration
• It is high-pitched, grating or scratching
• Best heard in sitting position
• Pericardial rub may appear and disappear within a day.

Causes of pericarditis (PericardiaI Diseases)

Infections —

• Viral – coxsackie virus, mumps, hepatitis, HIV
• Bacterial – Pneumococcus, streptococcus, sta­phylococcus,lubercular-
• Fun al – Histoplasma, candida

PericardiaI Diseases Other causes –

• syphilis, parasitic, protozoal
• Rheumatic fever
• Collagen vascular disease
• Drug induced – Procainamide, hydralazine, phenytoin
• Post cardiac injury – after MI, trauma.
• MI
• Uraemia
• Tumors – Benign, malignant
• Myxoedema
• Trauma
• Aortic dissection
• Acute idiopathic
• Sarcoidosis

ECG

• Elevation of ST se ments with concavity upwards in several leads.
• Low voltage ECG
• T inverted in several leads waves
• Q wave may be present.

PERICARDIAL EFFUSION

• Pericarditis may be associated with effusion in peri­cardial space called pericardial effusion.

PericardiaI Diseases Etiology: is same as pericarditis.

• In rheumatic fever there is no pericardial effusion.
• In uraemia, tuberculosis, malignancy, viral, bacterial causes there may be massive pericardial effusion.

PericardiaI Diseases Physical findings :

• Area of cardiac percussion is increased. Heart sounds are faint
• There may not be any friction rub NP is raised
• There may be ascites
• Apical cardiac impulse not palpable
• Ewart’s sign – dullness below left sca~la due t9 collapsed lung, may be prese’lt.

Chest X-ray

• Outline of heart is enlarged, and water bottle or flask-shaped or globular (rounded).

PericardiaI Diseases Echocardiography

• The best bedside tool for diagnosing pericardial effusion is echocardiography.
• Pericardial fluid can be seen as echo-free space between posterior pericardium and left ventricu­lar free wall or between anterior right ventricle and anterior chest wall.
• Pericardial thickening can be seen. Cardiac tamponade can also be identified.

CT I MRI

• CT and MRI can detect pericardial thickening and locu­lated effusion.

PericardiaI Diseases Treatment

• Treat the etiology
• IV fluids to increase cardiac output Pericardiocentesis – Pericardial fluid is aspirated under echocardiographic screening
• The fluid is sent for diagnosis
• Aspiration of fluid relieves the symptoms – thera­peutic aspiration
• Fluid is usually exudate
• Transudate is found in heart failure
• Bloody pericardial fluid is found in tuberculosis, uraemia, tumour, trauma.