Professional Documents
Culture Documents
Pericarditis
Pericarditis
disease
Tan Hong-Yong
Department of Diagnosis
Jining Medical College
What do you know about the
pericardium?
What is it ?
Where is it ?
Acute pericarditis
Pericardial effusion
Constrictive pericarditis
Acute pericarditis
Etiology
Inflammatory Pericarditis
Infection caused by living agents
Inflammation caused by noliving agents
Uremic Pericarditis
postmyocardial infarction or cardiac surgery
(Dressler’s syndrome)
Radiation therapy
Other pericarditis
• Collagen vascular
• myxedema
• Neoplastic disease (commonly lung or breast) –
6%
Viral Pericarditis
malignant mesothelioma.
not easy to decide whether the pericardial
Severe Hypothyroidism.
↓ cardiac contractility, mass, heart rate.
↑ peripheral vascular resistance.
may cause of pericardial effusion but not
usually .
Signs of cardiovascular dysfunction are not
common:
– Exertional dyspnea and exercise intolerance.
– Bradycardia.
– Hypertension (20-40%) .
– Cardiac dysfunction, with poor contractility,
dilatation or pericardial effusion.
– Edema.
Patient may appear to have congestive heart
failure. However, heart failure due solely to
hypothyroidism is rare.
Pathology and
pathophysiology
Inflammation provokes
a fibrinous exudate with
or without serous
effusion.
The normal transparent
and glistening
pericardium is turned
into a dull, opaque, and
“sandy” sac.
Pathology and
pathophysiology
It can cause
pericardial
scarring with
adhesions and
fibrosis-----
Constrictive
Pericarditis.
Pathophysiology
Pericardium relatively stiff
Symptoms of cardiac compression dependant on:
1. Volume of fluid
2. Rate of fluid accumulation
3. Compliance characteristics of the pericardium
A. Sudden increase of
small amount of fluid
(e.g. trauma)
B. Slow accumulation
of large amount of
fluid (e.g. CHF)
Cardiac Tamponade
Fluid under high pressure compresses the cardiac
chambers:
acute: trauma, LV rupture – may not be very large.
gradual: large effusion, due to any etiology of acute
pericarditis.
CardiacTamponade --
Pathophysiology
Accumulation of fluid under high pressure:
compresses cardiac chambers & impairs
diastolic filling of both ventricles
↓ SV ↑venous pressures
Ewart's sign:
Chest x-ray
ECG
Echo
Catheter laboratory investigations
Chest x-ray
CXR – globular
appearance to heart
and therefore
increased
cardiothoracic
ratio.
“water bottle”
shaped heart.
ECG (acute pericarditis)
ECG differential diagnosis
- MI
What leads is the ST elevation in?
What shape is the elevation?
Are there Q waves?
Do the ST –T changes evolve with time?
History of the patient.
Cardiac enzymes etc.
Pericardial effusion
EKG:
low voltage
“electrical
alternans”
Echocardiography
Echo – size of
effusion and
haemodynamic
effect of it.
Catheter lab
diastolic
equalization
of left and
right heart
pressures
High RA
pressures
Diagnosis of pericarditis
• ↑HR, ↓BP
• ascites, edema, hepatomegaly
• early diastolic “knock” after S2
• sudden cessation of ventricular diastolic filling
imposed by rigid pericardial sac
• Kussmaul’s sign
Kussmauls sign
Occasionally
calcification noted
More useful to
determine whether
there is a coexisting
effusion (fluid
accumulation)
Echo findings
Thick pericardium and small chambers.
Treatment
The only effective treatment for
chronic constrictive pericarditis is
complete surgical resection of the
pericardium.
Mortality for procedure ranges from 5-
16%.
Symptomatic improvement in 90%.
5 year survival rate is 74-87%
depending on co-morbidities pre-op.