M ORNING R EPORT Friday September 3, 2010

P ERICARDIUM Encloses Heart Ascending aorta Pulmonary trunk Terminal segment of the vena cavae Serous vs Parietal Fluid Ultrafiltrate of plasma

P ERICARDITIS Infectious Autoimmune Rheumatic fever Uremia Malignancy Drug reaction Post Surgical Idiopathic

V IRAL C AUSES 10 to 14 day prodromal illness Respiratory or GI Coxsackie Echo Adeno Epstein-Barr Influenza HIV

B ACTERIAL C AUSES Higher mortality Toxic Higher fever Irritability Cardiomegaly on CXR Spread from surgery or infection Staph and H.flu TB in immunocompromised

S IGNS AND S YMPTOMS 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

L ABS Elevation WBC ESR CRP Troponin Myocardial involvement Specific Cause Blood culture, viral culture, TB, RF, ANA

ECG

Stage 2 Normalization of the ST and PR segments Stage 3 Development of widespread T-wave inversions Step 4 Normalization of the T waves

P ERICARDIAL E FFUSION CXR “water-bottle heart” Echo Support the diagnosis

M ANAGMENT Treat the underlying cause Alleviate pain and inflammation NSAIDs Colchicine if recurrent or chronic (>2 weeks) What about steroids? Controversial Avoid Diuretics Avoid Intubation

C OMPLICATIONS Recurrence 1/3 Constrictive pericarditis Cardiac tamponade Tachycardia, hypotension, increased JVP, muffled heart sounds, hepatomegaly, narrow pulse pressure Pulsus paradoxus Electrical alternans

S TICK A NEEDLE IN IT ! Pericardiocentesis Hemodynamic compromise Cardiac tamponade Purulent pericarditis Neoplastic pericarditis Pericardial window or pericardiectomy Resistant cases