1. PERICARDIAL DISEASES

2. ACUTE PERICARDITIS This is inflammation of the pericardium May be : - Fibrinous - Serous - Haemorrhagic - Purulent

3. AETIOLOGY May be idiopathic or secondary to:  Viruses (coxsackie,flu,epstein-barr,mumps)  Bacteria (pneumonia,TB,staph,streps)  Fungi  MI  Drugs (penicillin,isoniazid,hydralazine,anti-neoplastic agents)  Others (uraemia,RA,SLE,myxoedema,malignancy,sarcoidosis )

4. Clinical Features - The characteristic pain of pericarditis is retrosternal, radiates to the shoulders and neck, and is typically aggravated by deep breathing, movement, a change of position, exercise and swallowing. - A low-grade fever is common. - A pericardial friction rub is a high-pitched superficial scratching or crunching noise produced by movement of the inflamed pericardium and is diagnostic of pericarditis; - it is usually heard in systole but may also be audible in diastole.

5. Investigations and management - The ECG shows ST elevation with upward concavity over the affected area, which may be widespread. - PR interval depression is a very specific indicator of acute pericarditis. - Later, there may be T-wave inversion particularly if there is a degree of myocarditis. - The pain is usually relieved by aspirin (600mg 4-hourly) but a more potent anti-inflammatory agent such as indomethacin (25mg 8-hourly) may be required. - Corticosteroids may suppress symptoms but there is no evidence that they accelerate cure.

6. Fliud in the pericardial sac There is sometimes a sensation of retrosternal oppression. An effusion is difficult to detect clinically. The heart sounds may become quieter, although a pericardial friction is not always abolished. PERICARDIAL EFFUSION

7. Diagnosis  CXR (cardiomegaly)  ECG (small and low QRS complex and sometimes abnormal shaped)  ECHO (show an echo-free zone surrounding heart)

8. Treatment  Treat cause  Pericardiocentesis (diagnostic for bacterial pericarditis and therapeutic for cardiac tamponade)  Pericardial fluid (culture, ZN stain/TB culture, cytology)

9.  Meaning the heart is encased in a rigid pericardium.  Progressive thickening, fibrosis and calcification of the pericardium.  Cause is unknown but can be TB or after any pericarditis. Constrictive Pericarditis

10. Clinical Features  Fatigue  Rapid, low-volume pulse  Pulsus paradoxus (excessive fall in BP during inspiration):  Sign of RHF  Kaussmaul sign (JVP increase w inspiration)  Quite heart sound  Hepatosplenomegaly  Ascites n oedema

11. Investigations and management  CXR (small heart)  CT and MRI (see pericardial calcification)  ECHO  Treatment : surgical incision!!

12. Cardiac Tamponade  Accumulation of pericardial fluid with raised intra- pericardial P, so poor ventricular filling, hence reduce CO..  Causes include :  Any pericarditis  Aortic dissection  Haemodylisis  Warfarin  Post cardiac biopsy  Post cardiac cathetherization

13. Sign  Tachycardia  Drop BP  Pulsus paradoxus  JVP raised  Kausmaul’s sign  Muffled S1 n S2

14. Diagnosis  Beck’s triad (fall BP, raised JVP, small n quiet heart)  CXR can be cardiomegaly (if >250mL fluid)  ECG low @ small QRS complex  ECHO (pericardial effusion, diastolic collapse of R atrium n R ventricle)

15. MANGMENT  Emergency Drainage