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Pericarditis
Pericarditis
Definition:
Is inflammation of pericardial layer of
the heart. pericardial layer covers the
heart and protect it from any
infection.
Causes:
I. Infection: is the most important cause:
A. Viral infection: this is the most important
cause in infection coxachi A virus.
And B commonest one. B3 , B5.
ECHO virus, influenza V. hepatitis V.
B. Bacterial infection – Tubercle bacilli
Staphylo coccus
Strepto coccus
Pneumo coccus
C.Fugal Infection
D.Parasitic Infection
Those causes same as the causes of
myocordotis and so the patient with
acute myocarditis can present with
pericarditis and vice versa that the
disease could start in the myocardium
and spread to the pericardium.
II. Hyper sensitively reaction.
• Follow myocardial infarction
dressler syndrome ).post
nd
pericardits 2 ry to M.I in 3rd
th
or 4 day of infection.(late
presentation ).
Post pericardiotomy syndrome .auto
immune self limiting disease affect pleura
and pericardium .common after cardiac
surgery specially mitral valve “mitral
comissuratomy”
Serum sickness and drug reaction as
(hydralazine)
III. Direct and indirect wound as
stab wound .
Iv.Metabolic disorders as uraemia. (most
important). Present with pericaditis
effusion and espically after
introduction of renal dialysis .The
pericardial effusion enhanced after
renal dialysis .
v. Myxedema.
vi.Malignancy like lymphoma.
vii.Aortic dissection + myocardial
infection.
viii. Cobalt pear cardiomyopathy. Pear can.
Lead to Myocarditis
cardiomyopathy
ix. Radiation therpay .
Clinical Finding
Depond on the:
- Type of inflammation.
- Sevirety of inflammation.
- Formation of pericardial fluid.
1. Dry pericarditis.
2. Percardial effusion without cardiac temponade.
3. Cardiac temponade.
4. Pericardial constriction.
ECG:
1/ Dry Pericarditis or Fibronous:
Symptoms:
• Chest pain:
It is precardial, sever, radiate to shoulder, so mimic the
acute myocardial infraction pain. But the pain of
pericarditis increase intensity with inspiration or lying
flat and improve when standing or sit down or leaning
forward ( (وضع الساجد.
• Fever:
Arthralgia rigors, anxiaty and general weakness.
Signs:
Pericardial rub: Is the harsh sound continuous
atrail systole, Ventricular systole and ventricular
diastole. It is superficial sound has no relation to
heart sound. Nearly periodical area. and easy to
heard when the patient hold it’s breathing so
you should differentiate between pleural rub and
pericardial rub. Pleural rub might be heard
during inspiration. Pericardial rub start to
disappear when effusion develops. And
pericardial pain improve.
Lab Finding:
Symptoms:
• disapperance of cheast pain.
1. ECG changes - Flat T wave.
- Low voltage ECG
Signs:
- Blood pressure normal.
- Pulse normal.
- Only heart sound become distant.
- Invisible cardiac pulse.
- Pericardial rub might disappear or
it may remain and this indication
to previous pericarditis so no pain
and no rub.
ECG:
Change in T wave not specific for P. effusion.
T wave flat or T wave inverted.
Low voltage.
Low QRS complex.
ECHO:
1. Pericardio- synthesis:
This is diagnostic and therapeutic.
2. Thoracotomy:
( an open drainage).
3/ Cardiac Temponade:
• In Temponade the amount of fluid inside pericardial sac
is increased. When intra pericardial pressure equal to the
diastolic pressure in the heart. ( the right vertical or right
atrial pressure) then temponade develops.
• The right side of the heart has less diastolic pressure
than left side of the heart and for that reason the cardiac
temponade compress right side of the heart because the
pressure reach to diastolic pressure of right ventricle or
right atrium before reach to left ventricle and so all
patients present with right side heart failure heart
problem.
Symptoms:
Patients is unconscious, severly sweating,
dizzness or may reach a circulatory shock.
Signs:
- Increase venous pressure :
(Kussmaul’s sign). called inspiratory filling of
superior vena cava.
- Cardiac impulse:
Are not palpable.
- Heart sound:
Are distant and this is same as P. effusion.
ECG:
• Ascitis:
ECG:
Non specific.
X-Ray:
Intraprecardial cacification
ECHO:
Absent of late diastolic filling.
D.D
Pericardiutomy