Transcript Morning Report

MORNING REPORT
Friday September 3, 2010
PERICARDIUM

Encloses
Heart
 Ascending aorta
 Pulmonary trunk
 Terminal segment of
the vena cavae

Serous vs Parietal
 Fluid


Ultrafiltrate of plasma
PERICARDITIS
Infectious
 Autoimmune


Rheumatic fever
Uremia
 Malignancy
 Drug reaction
 Post Surgical
 Idiopathic

VIRAL CAUSES

10 to 14 day prodromal illness

Respiratory or GI
Coxsackie
 Echo
 Adeno
 Epstein-Barr
 Influenza
 HIV

BACTERIAL CAUSES
Higher mortality
 Toxic

Higher fever
 Irritability

Cardiomegaly on CXR
 Spread from surgery or
infection
 Staph and H.flu


TB in immunocompromised
SIGNS AND SYMPTOMS

Chest pain
Substernal, sharp, worse with inspiration, relieved by
sitting upright and leaning forward
 Radiation to scapular ridge


Friction rub

Scratchy, high-pitched, to-and-fro
LABS

Elevation
WBC
 ESR
 CRP
 Troponin



Myocardial involvement
Specific Cause

Blood culture, viral culture, TB, RF, ANA
ECG
ECG

Stage 2


Stage 3


Normalization of the ST and PR segments
Development of widespread T-wave inversions
Step 4

Normalization of the T waves
PERICARDIAL EFFUSION

CXR


“water-bottle heart”
Echo

Support the diagnosis
MANAGMENT
Treat the underlying cause
 Alleviate pain and inflammation




NSAIDs
Colchicine if recurrent or chronic (>2 weeks)
What about steroids?

Controversial
Avoid Diuretics
 Avoid Intubation

COMPLICATIONS
 Recurrence

1/3
 Constrictive
pericarditis
 Cardiac tamponade
Tachycardia, hypotension, increased JVP, muffled
heart sounds, hepatomegaly, narrow pulse
pressure
 Pulsus paradoxus
 Electrical alternans

STICK A NEEDLE IN IT!

Pericardiocentesis
Hemodynamic compromise
 Cardiac tamponade
 Purulent pericarditis
 Neoplastic pericarditis


Pericardial window or
pericardiectomy

Resistant cases