Pericardial disease

• Acute pericarditis
• Constrictive pericarditis
• Cardiac tamponade
 Acute pericarditis
• Idiopathic >> viral and autoimmune
• TB ,HIV
• Neoplasm, trauma , uremia, irradiation
• Drugs (hydralazine , chemotherapy , penicillin)
• Hx , physical exam ,ECG ,ECHO
• NSAIDS and colchicine vs steroids ( second line )
• 30% recurrent pericarditis
• 1% constrictive pericarditis
• ECG : sinus tachycardia , electrical alternans
• Concave st elevation
• PR depression in all leads except aVR
 CONSTRICTIVE PERICARDITIS
• Chronic disorder results from pericardial inflammation,
fibrosis and possibly calcification
• Loss of elasticity , rigid pericardium >> total fixed
thoracic volume
• Symptoms of deminished cardiac output + fluid
overload
• JVP distension , kussmaul sign ( high JVP with
inspiration)
• Pulsus paradoxus , hepatomegaly and peripheral
edema
• Doppler ECHO or CATH ( equal diastolic pressure in all
chambers)
 tamponade
• Intrapericardial pressure exceeds intracardial
p >> impairment of filling through the entire
diastolic period
• Hx , hypotension , tachycardia , elevated JVP ,
pulsus paradoxus
• Cxr : water bottle heart
• ECG : sinus tachycardia , electrical alternans
 Pulmonary HTN
• Resting mean PAP of 25 mmhg or greater , or
>=30 mmhg with excercize
• Leads to RV failure and may directly
contribute to death
• Pathophysiology determined by the specific
cause , vast majority due to left sided heart
disease( volume and pressure overload) and
hypoxic respiratory disorders(
vasoconstriction )
• Disease localized to small pulmonary
arterioles >> high pul vasculature resistance
• Group 2 : Pul HTN due to left sided heart
disease
• Group 3 : due to lung disease and hypoxia (
COPD , ILD, others with mixed restrictive and
obstructive , sleep disorders , alveolar
hypoventilation , high attitude ,
developmental abnormalities
• Group 4 : chronic thromboembolic pul HTN
• Group 5 : unclear or multifactorial causes
 Group 5
- Hematologic disorders ( myeloproliferative ,
splenectomy)
- Systemic disorders ( sarcoidosis , vasculitis ..)
- Metabolic disorders ( thyroid , glycogen
storage dis ..)
- Others : tumoral obstruction , fibrosing
mediastinitis , ckd on dialysis
• Physical signs
• ECHO, right heart cath to confirm dx
• Group 2-5 : treat underlying cause
• Group 4 ( CTEPH ) : anticoagulation and
possible surgery
• PAH : vasodilators , rt heart cath , vasidilator
test ,