CC March 2016 Acute Pericarditis

echoecho's version from 2016-05-16 21:56


Question Answer
Define?an inflammation of the pericardium that is most often idiopathic, but can be due to a variety of underlying conditions
The disorder is acute if the signs and symptoms are no more than ____ weeks in duration?1-2
List the 9 categories of common etiologies of pericarditis?1) idiopathic (>40%; most common cause) 2) infectious 3) cardiac 4) autoimmune 5) neoplastic disease 6) metabolic 7) radiation-induced 8) medications 9) trauma
List the examples of infectious etiologies of pericarditis?1) viral 2) bacterial 3) myocobacterial 4) fungal 5) parasitic
List the examples of cardiac etiologies of pericarditis?1) early psotmyocardial infarction (MI) 2) late post-MI (Dressler syndrome) 3) dissecting aortic aneurysm 4) device and procedure-related
List the examples of autoimmune etiologies of pericarditis?1) connnective tissue disease (SLE, RA) 2) arteritis (polyarteritis nodosa, temporal arteritis) 3) inflammatory bowel disease
List the example of neoplastic disease etiologies of pericarditis?1) primary (lung, breast, Hodgkin's lymphoma, mesotheliuoma) or secondary
List the example of metabolic disease etiologies of pericarditis?uremia
List the example of medications etiologies of pericarditis?1) Hydralazine (Apresoline) 2) Isoniazid (Nydrazid) 3) phenytoin (dilantin) 4) rifampin (Rifadin) 5) procainamide (Procanbid)
List the example of trauma etiologies of pericarditis?1) blunt or penetrating trauma OR 2) following cardiopulmonary resuscitation (CPR)
Of patients presenting to the ER with chest pain not due to a myocardial infarction, only ____% have acute pericarditis?2-6%
What gender is most commonly affected? What age group is more often affected?men; adults
List the typical clinical presentation?1) severe, constant hest pain located over the anterior chest 2) pain may or may not radiate to the arms, neck, jaw or back 3) pain is often relieved when patient leans forward and is worse when supine
While a pericardial friction rub is highly speific, it is not present in all patient with acute pericarditis (low sensitivity), true or false?true
When present, the pericardial friction rub is best heard?at the end of expiration with the patient seated and leaning forward
Where should the diaphragm of the stethoscope be placed?firmly against the chest at the lower left sternal border
What is the sound of a pericardial friction rub on auscultation?high-pitched, scratchy or squeaky (squeaky shoe leather)
Although the dx of acute pericarditis is typically a clinical dx, what labs can be helpful in confirming the dx and revealing a potential underlying cause?viral titers, blood cultures
Due to the clinical presentation of chest pain, what labs should be done?CBC-D, ESR, CRP, cardiac enzymes, serial troponins
Troponins are elevated in _____% of patients with pericarditis?35-50%
What procedure is necessary and may show a pericardial effusion?echo
EKG findings vary based on the ____ of pericarditis?stage
What are present on the EKG in the stage 1 (acute stage) or pericarditis? What should be done?1) diffuse ST-segment elevations 2) careful evaluation to r/o ST elevation MI
Comment on the CXR?is usually normal unless there is a significant effusion causing enlargement of the cardiac silhouette
List the stages of EKG findings in acute pericarditis?1) stage I (elevated ST segments typicall concave up, upright T waves, isoelectric or depressed PR segments 2) stage II (normalized ST and PR segments 3) stage III (diffusely inverted T waves wtih normal ST segments) 4) stage IV (normal EKG)
*** What is the first-line treatment of acute pericarditis?1) NSAIDs (Ibuprofen 300-800 mg every 6-8 hours
If the patient has had a recent MI, ASA at what dose should be used instead?ASA 650-975 mg q 6-8 hours
What can be used for acute pericarditis and is the preferred agent for recurrent pericarditis?Colchicine
What medication regimen is recommended to lower recurrence risk, decreases symptosm at 72 hours, improves remission rates at 1 week adn better tolerated than NSAIDs alone??colchicine with NSAIDs
*** What medication should NOT be routinely used for rx of acute pericarditis becasue they are associated with an increased recurrence risk. They may be useful, however, if the underlyign cause of the perivarditis warrants steroid use (connective tissue disease)?glucocorticoids
What medications are not beneficial unless a causative specific bacterial agent is found?antibiotics
In addition to controlling the pain and inflammation of pericarditis, what conditions should be evaluated and treated?underlying conditions
Although outpatient medical therapy is sufficient for most patients, certain factors warrant hospitalization and further work-up, list these?1) fever > 38 C 2) evidence of cardiac tamponade 3) large pericardial effusion 4) hx of anticoagulant therapy 5) acute trauma 6) failure to respond to NSAID therapy 7) elevated cardiac troponin (which may indicate myopericarditis, a different disorder with different treatment)
List the 2 potential complications of acute pericarditis?1) cardiac tamponade 2) constrictive pericarditis
Define cardiac tamponade?rapid fluid accumulation in the pericardial sac that compresses the cardiac chambers and interferes with pumping. 2) 15% of pts with idiopathic pericarditis may be eaffected, while 60% of patients with neoplastic, tuberculous or purulent pericarditis are affected
Define constrictive pericarditis?occurs from scarring and loss of elasticity of the pericardium
Overall, pericarditis has a recurrence rate of ___%; recurrence is usually less severe for idiopathic and viral pericarditis?24%
In the absence of these complications and with proper management, patients with acute, idiopathic or viral pericarditis have a very _____ prognosis?good
*** SUMMARY = The typical clinical presentation of acute pericarditis is?severe, constant chest pain located over the anterior chest. The pain is often relieved when patients lean forward and is worse when supine
*** SUMMARY = List the initial blood work?1) CBC-D 2) ESR 3) CRP 4) cardiac enzymes 5) serial troponins
*** SUMMARY = What % of patients with acute pericarditis will have elevated troponin levels?35-50%
*** SUMMARY = List the indications for hospitalization and further work-up?1) fever > 38 C 2) evidence of cardiac tamponade or large pericardial effusion 3) hx of anticoagulant therapy 4) acute trauma 5) failure to respond to NSAID therapy or elevated cardiac troponin