RAPHAEL
Pericardial Disease
FYI Function of pericardium:
prevents sudden dilation of heart chambers
holds heart in place anatomically
retards spread of infection
serous fluid decreases friction between
heart and surrounding structures
Pericarditis
History: sudden onset sharp CP (with/without radiation to
trapezius) may be lessened by sitting forward
some patients may have no CP (esp renal failure pts)
Physical Exam:
May be normal
Pericardial friction rub ****
Pulsus parodoxus: pulse weaker with inspiration,
stronger with expiration (accentuated >10mmHg)
Kussmaul sign: elevated neck veins (and P) during
inspiration
CXR/EKG Findings
CXR
Effusion: cardiomegaly
EKG
ST segment concave upwards
PR depression
Effusion: low voltage and electrical
alternans
ECHO
Diagnostic Test
Can localize and estimate how much
fluid in effusion
May need CT/MRI to confirm
thickening, calcifications
Pericarditis in MI: in up to 40% in first 3 days, no
need to stop anticoagulation therapy
Post CABG Pericarditis: Dressler’s syndrome 4-6
weeks post op or post MI (fever, pluritic CP,
increased sed rate)
Constrictive pericarditis: occurs when acute
pericarditis or effusion heals (granulomatous tissue
contracts forming a “scar”)
Thick/rigid pericardium limits ventricular
filling
Treatment
Relieve CP (NSAIDs, steroids, narcotics)
Prevent inflammation (NSAIDs, steroids)
Tx underlying cause
Many possible causes: bacterial, viral, uremia,
neoplastic, drug induced, trauma…
Pericardiocentesis: remove fluid with a needle
Pericardial window: a portal for drainage from
pericardium into peritoneum
That’s It For Raphael!