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Pericardial Disease (Pericardium Anatomy (Fibrous parietal layer is 2ml…
Pericardial Disease
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Acute Pericarditis
Aetiology
Metabolic e.g. uraemia, myxoedema, hypothyroidism
Drugs e.g. penicillin, chemo
Autoimmune e.g. Sjogren syndrome, RA, SLE
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Bacterial - TB, Lyme disease, pneumonia
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Viruses - e.g. enteroviruses, herpes, mumps, HIV
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Pathophysiology
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A fibrinous reaction occurs, resulting in exudate and adhesions within the pericardial sac
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Signs
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Chest pain is relieved by sitting forwards as there is less pressure on the fibrous layer in this position
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Definition
= Acute inflammation of the pericardium, with or without effusion
Investigations
Chest X-Ray - can show cardiomegaly in cases of effusion, pneumonia
Bloods - increase in WBC, elevated troponin, high ESR
ECG - saddle shaped ST elevation, PR depression
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Physical Examination
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Beck's triad: Hypotension, elevated JVP, quiet heart sounds
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Relapse
Treat with NSAIDs, colchicine and steroids
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Pericardium Physiology
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Promotes cardiac efficiency by limiting dilation, maintaining ventricular compliance and distributing hydrostatic forces
If reserve volume is exceeded, the pressure is translated onto the cardiac chambers
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A small amount of volume added to the space will have a dramatic effect on filling - i.e. cardiac tamponade
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Pericardial Effusion
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Pathophysiology
Ventricular filling is compromised when fluid collects in the pericardial sac, leading to cardiac tamponade
Chronic accumulation of fluid causes the parietal pericardium to adapt, and in this case cardiac tamponade does not occur
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Cardiac Tamponade
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Signs
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Pulsus paraxodus
During inspiration, there is reduced intra thoracic and pericardial pressure and increased venous return to the RA and RV
= abnormally large decrease in stroke volume, and systolic BP
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When the pericardium has reduced compliance, the space for ventricles to expand is fixed
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