Pericarditis

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Today inahallah I'll talk about Pericarditis

The pericardium acts as a protective covering for the heart. It consists of two separate layers, the inner visceral pericardium and the outer parietal pericardium. The visceral pericardium reflects back upon itself at the level of the great vessels to join the parietal pericardium, thus forming a sac. The pericardial sac contains up to 50 mL of pericardial fluid in the normal heart, although this is a potential space for fluid to collect. The pericardium serves to lubricate the surface of the heart, prevents deformation and dislocation of the heart and acts as a barrier to the spread of infection

Presentations of pericardial diseaseinclude:

acute pericarditis

pericardial effusion and cardiac tamponade

constrictive pericarditis.

Acute pericarditis

This refers to inflammation of the pericardium. Classically, fibrinous material is deposited into the pericardial space and pericardial effusion often occurs. Acute pericarditis has numerous aetiologies

Viral pericarditis. The most common viral causes are Coxsackie B virus and echovirus. Viral pericarditis is usually painful but has a short time course and rarely long-term effects. Increasingly, HIV is implicated in the aetiology of pericarditis, both directly and via immunosuppression, which predisposes the subject to infective causes.

Post-myocardial infarction pericarditis
occurs in about 20% of patients in the first few days following MI. It occurs more commonly with anterior MI and ST elevation MI with high serum cardiac enzymes, but its incidence is reduced to 5– 6% with thrombolysis. It may be difficult to differentiate this pain from recurrent angina when it occurs early (day 1–2 post-infarct) but a good history of the pain and serial ECG monitoring is helpful. Pericarditis may also occur later on in the recovery phase after infarction. This usually occurs as a feature of Dressler’s syndrome, an autoimmune response to cardiac damage occurring 2–10 weeks post-infarct. Autoimmune reaction to myocardial damage is the main aetiology,
and antimyocardial antibodies can often be found. Recurrences are common. Differential diagnosis includes a new myocardial infarction or unstable angina.

Uraemic pericarditis is due to irritation of the pericardium by accumulating toxins. It can occur in 6–10% of patients with advanced renal failure if dialysis is delayed. It is an indication for urgent dialysis as it continues to be associated with significant morbidity and mortality.

Bacterial pericarditis may rarely occur with septicaemia or pneumonia, or it may stem from an early postoperative infection after thoracic surgery or trauma, or may complicate endocarditis. Staphylococcus aureus is a frequent cause of purulent pericarditis in HIV patients. This form of pericarditis, especially staphylococcal, is fulminant and often fatal. Other endemic infectious pericarditis includes mycoplasmosis and Lyme pericarditis which are often effusive and require pericardial drainage. The diagnosis is based on serological tests of pericardial fluid and identification of organisms in pericardial or myocardial biopsies.

Tuberculous pericarditis usually presents with chronic lowgrade fever, particularly in the evening, associated with features of acute pericarditis, dyspnoea, malaise, night sweats and weight loss. Pericardial aspiration is often required to make the diagnosis. Constrictive pericarditis is a frequent outcome.

Fungal pericarditis is a common complication of endemic fungal infections, such as histoplasmosis and coccidioidomycosis but may be also caused by Candida albicans, especially in immunocompromised patients, drug addicts or after cardiac surgery.

Malignant pericarditis. Carcinoma of the bronchus, carcinoma of the breast and Hodgkin’s lymphoma are the most common causes of malignant pericarditis. Leukaemia and malignant melanoma are also associated with pericarditis. A substantial pericardial effusion is very typical and is due to the obstruction of the lymphatic drainage from the heart. The effusion is often haemorrhagic. Radiation and therapy for thoracic tumours may cause radiation injury to the pericardium resulting in serous or haemorrhagic pericardial effusion and pericardial fibrosis. Absence of neoplastic cells in the pericardial fluid in these conditions often helps diagnosis.

Clinical features

· Pericardial inflammation produces sharp central chest pain exacerbated by movement, respiration and lying down .

· It may be referred to the neck or shoulders.

· The classical clinical sign is a pericardial friction rub occurring in three phases corresponding to atrial systole , ventricular systole and ventricular diastole .

· It may also be heard as a biphasic ‘to and fro’ rub.

· The rub is heard best with the diaphragm of the stethoscope at the lower left sternal edge at the end of expiration with the patient leaning forward.

· There is usually a fever, leucocytosis or lymphocytosis when pericarditis is due to viral or bacterial infection, rheumatic fever or myocardial infarction.

· Features of a pericardial effusion may also be present

· Large pericardial effusion can compress adjacent bronchi and lung tissue and may cause dyspnoea

Investigations
· ECG is diagnostic.
· Cardiac enzymes should be assayed as they may be elevated if there is associated myocarditis
· Chest X-ray, echocardiograms and radionucleotide scans are of little value in uncomplicated acute pericarditis.

Treatment

· Bed rest and oral NSAIDs (high-dose aspirin, indocin or ibuprofen) are effective in most patients.

· Corticosteroids

If pericarditis persists for 6–12 months following the acute episode, it is considered chronic. If the pericardium thickens and restricts ventricular filling, constrictive pericarditis is said to have developed.

So there are another type of pericarditis :

Pericardial effusion and cardiac tamponade

Constrictive pericarditis

That’s all about pericarditis …

Plz Everyone read this topic say mashallh

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