ACUTE PERICARDITIS
Acute pericarditis is a syndrome due to inflammation of the pericardium characterized by chest pain ,a pericardial friction rub ,and a serial electrocardio-graphic abnormalities
The incidence :ranges from 2-6%(several autopsy series). men>woman
1.the most common causes:
idiopathic ,viral pericarditis,uremia,bacterial infection ,acute myocardial infarction, pericardiotomy, tuberculosis,neoplasm, and trauma …
2.pathological changes:
presence of polymorphnuclear leukocytes, increased pericardial vascularity and deposition of fibrin.
3.History
①.Chest pain is the chief complaint,its quality and location are variable.
Common locations:retrosternal and left precardial regions. Radiates to the trapezius ridge and neck.
Pain aggravated by lying supine,coughing,deep inspiration and swallowing,pain eased by sitting up,leaned forward.
Ischemic pain Pericardial pain
Location retosternal , left shoulder,arm precardium:left trepezius
ridge
Quality pressure, burning, buildup sharp, dull, pleuritic
Thoracic motion no effect increased by breathing
Duration angina: 1 or 2 to 15 min hours or days
unstable: 1/2hr to hours
Effort angina:usually no relation
unstable:usually not
Posture no effect; may sit,belch,use leaning forward for relief
valsalva knee-chest position aggravated by recumbency
for relief
②Dyspnea is aggravated by fever,large pericardial effusion ③Additional symptoms:cough, sputum production,weight loss. In elderly patients the chest pain and dyspnea are subtle.
4.Physical examination
The friction rub:a scratching,grating,high-pitched sound ,the sound is believed to arise from friction between the roughened pericardial and epicardial surfaces.
Ewart sign
The pericardial friction rub is classically described as having three components that are related to cardiac motion during atrial systole(presystole),ventricular systole and rapid ventricular filling in early diastole. Location: lower left sternal border. Important feature: often evanescent and change in quality
Detection of rub: stethoscope applied firmly to the chest at the lower left sternal border during inspiration and full expiration with the patient sitting up and lean forward.
12.Cardiac tamponade:
①elevation of intracardiac pressure
②progressive limitation of ventricular diastolic filling
③reduction of stroke volume and cardiac output.
Clinic manifestation:
①a decline in systemic arterial pressure
②elevation of systemic venous pressure
③a small, quiet heart.
Jugular venous distention, tachypnea, tachycardia , pulsus paradoxus, hypatomegaly.
pulsus paradoxus:an inspiratory decrease in the amplitude of palpated pulse in the femoral or carotid arteries.
Laboratory studies:
ECG: electrical alternans
UCG
5.Electrocardiagram: four stages
Stage Ι:comprise ST segment elevation is concave upward and present in all leads except avR and V1. T waves are upright.
Stage Ⅱ: ST segments return to baseline, T wave flattening.
Stage Ⅲ: T waves in normal
Stage IV: reversion of T wave changes to normal Others: isolated,PR-segment depression,sinus tachycardia, atrial arrhythemias.
Echocardiogram: is the most sensitive and accurate tool in the detection and quantification of pericardial fluid.
.Electrocardiagram
6.Blood test :
leukcytosis and elevation of the sedimentation.
7. The chest roentgenogam: for a large pericardial effusion,the X-ray show both enlargement and changes in configuration of the cardiac sihouette provide clues to the underlying cause of the pericarditis.
8.Pericardicentesis and biopsy.
The chest roentgenogam
9.Management:
①detect an underling disease that requires specific therapy
②pain relief:nonsteroidal anti-inflammatory agents:aspirin,indomethicia or corticosteroids.
③antibiotics: purulent pericarditis
10.Natural history: viral, idiopathic, post-myoca