1. Pericardial Diseases Dennis J. Esterbrooks M.D.

2. 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

3. Disease of the Pericardium Acute pericarditis Pericardial tamponade Chronic constrictive pericarditis

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

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

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

7. Acute Pericarditis Diagnostic Studies Chest X-Ray ECG Echocardiography

8. Pericarditis Acute ECG Changes

9. Pericarditis Evolutionary ECG Changes

10. ECG Acute Injury

11. ECG Early Repolarization

12. 2-D Echo Pericardial Effusion IF268.mov

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

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

15. Pericardial Effusion Rate of Accumulation

16. Tamponade Physiology

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

18. Pericardial Tamponade Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

19. Cardiac Tamponade

21. 2-D Echo Tamponade IF269.mov

22. Transmitral Flow Tamponade

23. Tamponade Paradoxical Pulse

24. Hemodynamics Tamponade

25. Pericardial Tamponade Management Fluid Expansion Inotropic Support Pericardial Drainage

26. Tamponade Pericardiocentesis

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

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

29. Constrictive Pericarditis Diagnostic Studies ECG Radiographic Echocardiography Hemodynamics

30. Constriction Chest X-Ray

32. 2-D Echo Constriction IF274.mov

33. Transmitral Flow Constriction

34. Venous Wave form Constriction

35. Cardiac Compression Venous Wave Forms

36. Hemodynamics Constriction

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

38. 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

39. Echocardiography Effusion

40. Echocardiography Tamponade

41. Echocardiography after Pericardiocentesis

42. Echocardiography Constriction

43. Echocardiography Tamponade