{"id":9618,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/pericardial-diseases\/"},"modified":"2021-12-28T23:26:11","modified_gmt":"2021-12-28T21:26:11","slug":"pericardial-diseases","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/pericardial-diseases\/","title":{"rendered":"Pericardial diseases"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Pericarditis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Acute pericarditis is an inflammation of the pericardium.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Can come on its own or as a consequence of another disorder.<\/li><li>Can be <strong>acute<\/strong> (&lt;2 weeks), <strong>subacute<\/strong> (>2 weeks), <strong>chronic<\/strong> (>6 months), and <strong>recurrent<\/strong>.<\/li><li>Patients present with fever, chest pain, and dyspnea. <ul><li>The pain may radiate and imitate MI, and is worse when laying down.<\/li><li>Additional symptoms depend on the severity and progression of the disease, along with complications.<\/li><\/ul><\/li><li>Complications include <strong>pericardial effusion<\/strong>, <strong>cardiac temponade<\/strong>, and <strong>constrictive pericarditis<\/strong>.<\/li><li><strong>Dressler syndrome<\/strong> or <strong>post-MI syndrome <\/strong>is pericarditis appearing 2 weeks after an acute MI. It is less common nowadays.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Infection (coxakievirus)<\/li><li>MI<\/li><li>Tumor<\/li><li>Trauma<\/li><li>Uremia (CKD)<\/li><li>Autoimmune disorders<\/li><li>Connective tissue disorders<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li>Upon auscultation, systolic and diastolic pericardial rub can be heard on the left sternal border<\/li><\/ul><\/li><li>ECG<ul><li>ST elevation along with PR depression.<\/li><\/ul><\/li><li>Cardiac enzymes may be slightly elevated.<\/li><li>Echocardiography<\/li><li>MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Treating the cause<\/li><li>Rest<\/li><li>High dose NSAIDs for 1-2 weeks with PPI<\/li><li>Colchicine<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Pericardial effusion<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Pericardial effusion is the filling of the pericardium with fluid (>50mL), typically secondary to pericarditis.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>By itself, pericardial effusion is painless; the symptoms generally arise from the pericarditis.<\/li><li>The effusion can be serous or contain blood, pus, or chyle (lymphatic fluid).<\/li><li>Can progress into <strong>cardiac temponade<\/strong> if it becomes filled with large amounts of fluid.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li>Muffled heart sounds<\/li><li>Enlarged cardiac dullness<\/li><\/ul><\/li><li>ECG may show low-voltage QRS complexes<\/li><li>Echocardiography<\/li><li>Chest x-ray shows enlarged, &#8220;bottle shaped&#8221; heart<\/li><li>MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Treat the pericarditis<\/li><li>Pericardiocentesis is not recommended unless there&#8217;s a risk for cardiac tamponade<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Cardiac temponade<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">Cardiac tamponade is a life-threatening pericardial effusion that interferes with cardiac filling.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The rate of fluid accumulation is more important than the volume; <strong>fast filling is more fatal<\/strong>, as slow filling may allow time for accomodation.<\/li><li>Presents with <strong>pulsus paradoxus<\/strong> (decline of over 10mmHg upon inspiration), and <strong>Beck&#8217;s triad<\/strong> (low blood pressure, jugular vein distension, and muffled heart sounds).<\/li><li>As the pericardium becomes filled, it interferes with the ventricular filling, the pressures within the four chambers and the pericardium equalize.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Penetrating injury<\/li><li>Iatrogenic<\/li><li>Cardial rupture (in MI)<\/li><li>Aortic dissection<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<p class=\"wp-block-paragraph\">The diagnosis is clinical and confirmed using echocardiography; additional steps are similar to pericardial effusion.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Hemodynamic stabilization<\/li><li>Surgery to stop the bleeding (in case of hemorrhagic temponade)<\/li><li>Pericardiocentesis (temporary measure, should not delay surgery)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_12\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Constrictive pericarditis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_12\">\n\n\n<p class=\"wp-block-paragraph\">Constrictive pericarditis is the fibrosis and thickening of the pericardium.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Most cases are idiopathic<\/strong> or due to a viral infection, other causes are similar to those of pericarditis.<\/li><li>The rigid pericardium interferes with ventricular filling during late diastole, impeding it <strong>abruply<\/strong>.<ul><li>In cardiac temponade, the filling impedment is <strong>gradual<\/strong>.<\/li><\/ul><\/li><li>Patients present with symptoms similar to either right or left heart failure, or a combination (periperal edema, ascites, dyspnea on exertion, fatigue), and sometimes atrial fibrillation.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_13\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_13\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li>On auscultation, late-diastolic &#8220;pericardial knock&#8221; (abrupt impedment of ventricular filling)<\/li><li><strong>Kussmaul sign<\/strong> (increase in jugular venous pressure during inspiration)<\/li><\/ul><\/li><li>ECG shows nonspecific changes<\/li><li>Echocardiography<\/li><li>MRI<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_14\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_14\">\n\n\n<ul class=\"wp-block-list\"><li>Treat the cause<\/li><li>Diuretics<\/li><li>Surgery<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Pericarditis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Pericardial effusion<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Cardiac temponade<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Constrictive pericarditis<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Pericarditis Acute pericarditis is an inflammation of the pericardium. Can come on its own or as a consequence of another disorder. Can be acute (&lt;2 weeks), subacute (>2 weeks), chronic (>6 months), and recurrent. Patients present with fever, chest pain, and dyspnea. The pain may radiate and imitate MI, and is worse when laying down. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9618","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pericardial diseases &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/pericardial-diseases\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/pericardial-diseases\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/pericardial-diseases\\\/\",\"name\":\"Pericardial diseases &#8211; 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