PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment

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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.

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PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment

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.

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PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment


 

Causes of pericarditis (PericardiaI Diseases)

Infections —

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

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PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment

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.

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PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment

 

Chest X-ray

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

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PericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment

 

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.
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