the pericardium
DESCRIPTION
Meant for MBBS students. Not for higher levels. Could be more detailed. Tailored for a 1 hour lecture.TRANSCRIPT
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THE PERICARDIUMWhat can go wrong with
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ANATOMY PRECIS
PERICARDIUM
Fibrous
Serous
Parietal
Visceral
Pericardial sac
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ANATOMY ADDL
Parietal and VisceralContinuous at roots of great vessels
FibrousAttached to diaphragm, great vessels
Pericardial sac50mlFrom mesothelial cells
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QUANDRIES
Pericarditis Constriction Effusion Tamponade Tumours
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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
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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
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CONSTRICTIVE PERIC
Pathophysiology –Smaller vol, Higher press↑JVP, prominent X&Y descents
Causes –All pericarditis causesInflammation→fibrosis→calcification
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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
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CONSTRICTIVE 3
Rx – DiureticsPericardiectomyNormalizes – days to weeks
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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
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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
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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
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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
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TREATMENT (Effu/Tamp)
Tamponade -Emergency pericardiocentesis (pigtail cath)Recc/rapid – pericardial window
Effusion –Drain +/-Rx causes
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TUMOURS
Secondary –Breast, lung, malig melanoma, lymphoma,
leukaemia Primary –
Mesothelioma, sarcoma