Pericarditis Aortic dissection
Acute pericarditis Definition a medical emergency resulting from a tear in the aortic wall
Definition inflammation of the sac surrounding the heart (pericardium) intima, which causes blood flow into a new false channel, composed of
usually lasting < 6 weeks the inner and outer layers of the media
Aetiology Aortic dissection is a rare but serious cause of chest pain
Viral infections (Coxsackie), TB, uraemia (causes ‘fibrinous’ pericarditis),
trauma, post- MI Dressler’s syndrome, connective tissue disorder, Associations HTN, trauma, bicuspid aortic valve, collagens: Marfan’s
hypothyroidism, malignancy syndrome, Ehlers-Danlos syndrome, Turner’s + Noonan’s syndrome,
Signs + symptoms pregnancy, syphilis
Chest pain: may be pleuritic: often relieved by sitting forward
Non-productive cough, dyspnoea and flu-like symptoms Signs + symptoms
Pericardial rub Chest pain: typically severe, radiates to the back and ‘tearing’
Tachypnoea in nature
Tachycardia
Aortic regurgitation
ECG changes Widespread ‘saddle-shaped’ ST elevation, PR depression:
HTN
most specific ECG marker for pericarditis
Other features may result from the involvement of specific
Constrictive pericarditis arteries
Definition: chronic inflammation of the pericardium scarring + o Coronary arteries angina
thickening muscle tightening impedes normal diastolic filling
o Spinal arteries paraplegia
Aetiology
Any cause of pericarditis (particularly TB) o Distal aorta limb ischaemia
Signs + symptoms
Dyspnoea, RHF (elevated JVP, ascites, oedema, hepatomegaly) Classification
JVP shows prominent x and y descent Stanford classification
Pericardial knock- loud S3 Type A ascending aorta (2/3 cases)
Kussmaul’s sign is positive (raised JVP during inspiration) Type B descending aorta, distal to left subclavian (1/3 cases)
CXR: pericardial calcification DeBakey classification
Type I originate in ascending aorta, propagate to at least aortic
Cardiac
Features
tamponade
Constrictive pericarditis arch + possibly beyond it distally
JVP Absent Y descent X + Y descent
Type II originates in and is confined to ascending aorta
Pulsus paradoxus Present Absent Type III originates in descending aorta rarely extends proximally
Kussmaul’s sign Rare Present but will extend distally
Characteristic Pericardial calcification on Mx
features CXR IV beta-blockers + nitrates
Type A surgical management; BP should be controlled to a target
Mx systolic of 100-120 mmHg whilst awaiting intervention
Analgesia e.g. paracetamol/ibuprofen + Anti-inflammatory e.g. steroids Type B conservative management, bed rest + reduce BP + IV labetalol
Severe effusion pericardiocentesis (draining excess fluid) to prevent progression
Acute pericarditis Definition a medical emergency resulting from a tear in the aortic wall
Definition inflammation of the sac surrounding the heart (pericardium) intima, which causes blood flow into a new false channel, composed of
usually lasting < 6 weeks the inner and outer layers of the media
Aetiology Aortic dissection is a rare but serious cause of chest pain
Viral infections (Coxsackie), TB, uraemia (causes ‘fibrinous’ pericarditis),
trauma, post- MI Dressler’s syndrome, connective tissue disorder, Associations HTN, trauma, bicuspid aortic valve, collagens: Marfan’s
hypothyroidism, malignancy syndrome, Ehlers-Danlos syndrome, Turner’s + Noonan’s syndrome,
Signs + symptoms pregnancy, syphilis
Chest pain: may be pleuritic: often relieved by sitting forward
Non-productive cough, dyspnoea and flu-like symptoms Signs + symptoms
Pericardial rub Chest pain: typically severe, radiates to the back and ‘tearing’
Tachypnoea in nature
Tachycardia
Aortic regurgitation
ECG changes Widespread ‘saddle-shaped’ ST elevation, PR depression:
HTN
most specific ECG marker for pericarditis
Other features may result from the involvement of specific
Constrictive pericarditis arteries
Definition: chronic inflammation of the pericardium scarring + o Coronary arteries angina
thickening muscle tightening impedes normal diastolic filling
o Spinal arteries paraplegia
Aetiology
Any cause of pericarditis (particularly TB) o Distal aorta limb ischaemia
Signs + symptoms
Dyspnoea, RHF (elevated JVP, ascites, oedema, hepatomegaly) Classification
JVP shows prominent x and y descent Stanford classification
Pericardial knock- loud S3 Type A ascending aorta (2/3 cases)
Kussmaul’s sign is positive (raised JVP during inspiration) Type B descending aorta, distal to left subclavian (1/3 cases)
CXR: pericardial calcification DeBakey classification
Type I originate in ascending aorta, propagate to at least aortic
Cardiac
Features
tamponade
Constrictive pericarditis arch + possibly beyond it distally
JVP Absent Y descent X + Y descent
Type II originates in and is confined to ascending aorta
Pulsus paradoxus Present Absent Type III originates in descending aorta rarely extends proximally
Kussmaul’s sign Rare Present but will extend distally
Characteristic Pericardial calcification on Mx
features CXR IV beta-blockers + nitrates
Type A surgical management; BP should be controlled to a target
Mx systolic of 100-120 mmHg whilst awaiting intervention
Analgesia e.g. paracetamol/ibuprofen + Anti-inflammatory e.g. steroids Type B conservative management, bed rest + reduce BP + IV labetalol
Severe effusion pericardiocentesis (draining excess fluid) to prevent progression
