Pericardial Diseases Dennis J. Esterbrooks M.D.

Pericardial Functions Maintain relation between right and left ventricles Limit acute cardiac dilatation Facilitate atrial filling Anatomically anchor the heart Avoid spread of infection to the heart

Disease of the Pericardium Acute pericarditis Pericardial tamponade Chronic constrictive pericarditis

Acute Pericarditis Definition Acute Pericardial Inflammation Which Is Manifest As A Clinical Triad of Chest Pain, Pericardial Friction Rub And ECG Changes

Common Etiologies of Pericarditis Idiopathic Viral Pyogenic Uremic Neoplastic Cardiac Injury Collagen Vascular Diseases

Acute Pericarditis Diagnostic Studies CBC Sed Rate FANA Blood Cultures Renal Function TB Skin Test

Acute Pericarditis Diagnostic Studies Chest X-Ray ECG Echocardiography

Pericarditis Acute ECG Changes

Pericarditis Evolutionary ECG Changes

ECG Acute Injury

ECG Early Repolarization

2-D Echo Pericardial Effusion IF268.mov

Acute Pericarditis Management Bed Rest and Observation Non-steroidal Anti-inflammatory Agent Steroids Pericardial Drainage

Pericardial Tamponade Definition Elevated CVP Secondary to Compression of the Heart By Pericardial Fluid

Pericardial Effusion Rate of Accumulation

Tamponade Physiology

Pericardial Tamponade Physical Findings Elevated Jugular Venous Pressure Tachycardia Narrow Pulse Pressure Paradoxical Pulse “ Small Quiet Heart “

Pericardial Tamponade Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

Cardiac Tamponade

2-D Echo Tamponade IF269.mov

Transmitral Flow Tamponade

Tamponade Paradoxical Pulse

Hemodynamics Tamponade

Pericardial Tamponade Management Fluid Expansion Inotropic Support Pericardial Drainage

Tamponade Pericardiocentesis

Chronic Constrictive Pericarditis Definition Elevated CVP Secondary to Compression of the Heart By the Pericardium

Constrictive Pericarditis Physical Findings Elevated Jugular Venous Pressure Kussmal’s Sign Pericardial Knock Narrow Pulse Pressure Hepatosplenomegaly Ascites Peripheral Edema

Constrictive Pericarditis Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

Constriction Chest X-Ray

2-D Echo Constriction IF274.mov

Transmitral Flow Constriction

Venous Wave form Constriction

Cardiac Compression Venous Wave Forms

Hemodynamics Constriction

Constrictive Pericarditis Management The Sub acute Phase May Respond to Non-steroidal Anti-inflammatory Agents Chronic Constrictive Pericarditis Is Best Managed By Pericardial Stripping

Comparison of Tamponade and Constriction Feature Tamponade Constriction Effusion Present Absent Calcification Absent Often Present Dip-plateau Inconspicuous Prominent Venous Waveform X or Xy XY or xY Pulses Paradox Present Inconspicuous Kussmal’s Sign Absent Often Present Pericardial Knock Absent Often Present

Echocardiography Effusion

Echocardiography Tamponade

Echocardiography after Pericardiocentesis

Echocardiography Constriction

Echocardiography Tamponade