The pericardium
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Transcript of The pericardium
THE PERICARDIUMWhat can go wrong with
ANATOMY PRECIS
PERICARDIUM
Fibrous
Serous
Parietal
Visceral
Pericardial sac
ANATOMY ADDL
Parietal and VisceralContinuous at roots of great vessels
FibrousAttached to diaphragm, great vessels
Pericardial sac50mlFrom mesothelial cells
QUANDRIES
Pericarditis Constriction Effusion Tamponade Tumours
PERICARDITIS Pericardial inflammation Causes:-
Infection○ Viral – Coxsackie B, Hep B, HIV, Mumps, Rubella○ Bact – TB, Staph, Strep○ Other – Actinomycosis, Coccidiomycosis, Histoplasmosis
Myocardial infarction○ Immediate – transmural○ Dressler – 3-4 weeks
Autoimmune○ SLE, RA, Systemic sclerosis, Churg Strauss
Other○ Irradiation, CRF, Uraemia, Hypothyroidism
PERICARDITIS 2 Clinical features
Chest pain – at rest, sudden, sharp, continuous, sitting relief, insp increase
Pericardial rub – scratchy, creaky, anywhere, heart beat sync
ECG – gen ST ↑, concave upwardsCXR – Cardiomegaly +/-Tamponade +/-
ManagementNSAIDsUnderlying causeSpecial - steroids
CONSTRICTIVE PERIC
Pathophysiology –Smaller vol, Higher press↑JVP, prominent X&Y descents
Causes –All pericarditis causesInflammation→fibrosis→calcification
CONSTRICTIVE 2
Clinical features –Dyspnoea, abd swelling, pedal edema,
jaundice (Rt side failure)JVP, prominent X&Y, pericardial knock, AFAscites, hepatomegaly
CXR – pericardial calcification ECG – low volt, nonspecific ECHO – Rt atrium press changes CATH – diagnostic press changes
CONSTRICTIVE 3
Rx – DiureticsPericardiectomyNormalizes – days to weeks
PERICARDIAL EFFUSION
>50ml of pericardial fluid Causes :-
Acute –○ Trauma, cardiac surgery, iatrogenic ventric
puncture, aortic dissection, free wall ruptureChronic –
○ viral, bacterial○ uraemia, autoimmune, myxodema, CCF, renal
failure, cirrhosis liver○ MI, malignancy
EFFUSION 2
Clinical features:-Cause, pericardium condition, rate, amount.Fast = tamponadeAsymptomatic – commonNonspecific - ↓ exercise tolerance, dull
chest pain, dyspnoea, hoarse voice, coughExam - ↑ cardiac dull area, muffled S1S2CXR – cardiomegaly (>250ml), globularECG – electrical alternansECHO - >100ml
TAMPONADE
NOT diagnosis but a physiology Haemodynamic instability due to
chamber compression when intrapericardial pressure > filling pressure of ventricles
Chamber filling ↓ Rt atrium/ventricle collapse Causes – All acute peric effusion
TAMPONADE 2 Clinical features –
DyspnoeaCirculatory collapseTachycardia, pulsus paradoxus↑ JVP, Kussmaul’s sign (↑JVP on insp)
CXR – Cardiomeg, globular, pulmonary edema (+/-)
ECG – tachy, low volt QRS, electrical alternans
ECHO – effusion, RA/RV collapse
TREATMENT (Effu/Tamp)
Tamponade -Emergency pericardiocentesis (pigtail cath)Recc/rapid – pericardial window
Effusion –Drain +/-Rx causes
TUMOURS
Secondary –Breast, lung, malig melanoma, lymphoma,
leukaemia Primary –
Mesothelioma, sarcoma