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Pericardial disease: 2 presentations - 1. Chest pain 2. dyspnea
acute pericarditis: inflammation of pericardium. Edema is seen. Etiology: unknown, self limited (echo virus, coxsachie type B). STEMI - DAMPs - PMNs. can get acute pericarditis in the first week. Malignancy - seeding (breast and lung). Connective tissue diseases (SLE or RA). Uremia. TB. clinical presentation: chest pain (acute), sharp, positional (better sitting up), radiates over trapezial ridge (towards shoulders). P/E - rub. Dx - EKG diffuse increase ST segments. Echo - 60% normal. CT/MRI: edematous thickening of pericardium. Natural Hx: benign self limited if idiopathic.
Effusions and Tamponade
Sx - restrictive filling (volume vs rate of accumulation) Chronic effusions (weeks to months) - Sx - none. P/E - muffled sounds. EKG: less amplitude of QRS complex. Echo is main way. Acute effusions: restricted filling Sx: right sided congestion, decrease CO (weakness, inability to sustain activity) P/E - JVD, pitting edema, hepatomegaly, pulsus paradoxus (decrease of stroke volume during inspiration) Dx: CXR (big heart shadow/silhouette. Echo (compression of chambers and fluid) Tx: aspiration (relief of pressure)
Constrictive pericarditis: rigid fibrosis of pericardium. Pathophys: inspiration has no ability to expand RV - decease in CO (pulsus parodoxus) - R sided congestion w Kussmaul sign (increase in JVD) Echo will show fibrosis not edema. Tx is percardiectomy
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