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Morning Report

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MORNING REPORT Friday September 3, 2010 PERICARDIUM Encloses Heart Ascending aorta Pulmonary trunk Terminal segment of the vena cavae Serous vs Parietal Fluid ... – PowerPoint PPT presentation

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Title: Morning Report


1
Morning Report
  • Friday September 3, 2010

2
(No Transcript)
3
(No Transcript)
4
Pericardium
  • Encloses
  • Heart
  • Ascending aorta
  • Pulmonary trunk
  • Terminal segment of the vena cavae
  • Serous vs Parietal
  • Fluid
  • Ultrafiltrate of plasma

5
Pericarditis
  • Infectious
  • Autoimmune
  • Rheumatic fever
  • Uremia
  • Malignancy
  • Drug reaction
  • Post Surgical
  • Idiopathic

6
Viral Causes
  • 10 to 14 day prodromal illness
  • Respiratory or GI
  • Coxsackie
  • Echo
  • Adeno
  • Epstein-Barr
  • Influenza
  • HIV

7
Bacterial Causes
  • Higher mortality
  • Toxic
  • Higher fever
  • Irritability
  • Cardiomegaly on CXR
  • Spread from surgery or infection
  • Staph and H.flu
  • TB in immunocompromised

8
Signs and Symptoms
  • Chest pain
  • Substernal, sharp, worse with inspiration,
    relieved by sitting upright and leaning forward
  • Radiation to scapular ridge
  • Friction rub
  • Scratchy, high-pitched, to-and-fro

9
Labs
  • Elevation
  • WBC
  • ESR
  • CRP
  • Troponin
  • Myocardial involvement
  • Specific Cause
  • Blood culture, viral culture, TB, RF, ANA

10
ECG
11
ECG
  • Stage 2
  • Normalization of the ST and PR segments
  • Stage 3
  • Development of widespread T-wave inversions
  • Step 4
  • Normalization of the T waves

12
Pericardial Effusion
  • CXR
  • water-bottle heart
  • Echo
  • Support the diagnosis

13
Managment
  • Treat the underlying cause
  • Alleviate pain and inflammation
  • NSAIDs
  • Colchicine if recurrent or chronic (gt2 weeks)
  • What about steroids?
  • Controversial
  • Avoid Diuretics
  • Avoid Intubation

14
Complications
  • Recurrence
  • 1/3
  • Constrictive pericarditis
  • Cardiac tamponade
  • Tachycardia, hypotension, increased JVP, muffled
    heart sounds, hepatomegaly, narrow pulse pressure
  • Pulsus paradoxus
  • Electrical alternans

15
Stick a needle in it!
  • Pericardiocentesis
  • Hemodynamic compromise
  • Cardiac tamponade
  • Purulent pericarditis
  • Neoplastic pericarditis
  • Pericardial window or pericardiectomy
  • Resistant cases
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