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DISEASES of the PERICARDIUM

(from readings on Monday, Sept 27th

  • pgs 311-324)

Objectives: (see last 2 pages of this study guide for specific summaries tailored to

objectives)

  • Recognize the clinical symptoms, physical findings, electrocardiographic changes, and diagnostic imaging abnormalities in cardiac tamponade

  • Contrast and differentiate the pathophysiology and clinical findings in cardiac tamponade from pericardial constriction

  • Recognize indications and develop a rational therapeutic plan for medical and surgical treatment of pericardial disease

What is the pericardium?

  • A 2 layered sac holding the heart Æ inner visceral and outer parietal layers

Acute Pericarditis

Most common disease of the pericardium = inflammation of its layers ETIOLOGY

  • Lots of causes, some of the more common are listed below (sorry, this is long…)

  • Infectious

    • o

      Idiopathic and Viral pericarditis

      • Most common cause

      • o

        Tuberculous Pericarditis

      • o

        Nontuberculous Bacterial Pericarditis (Purulent)

  • Noninfectious

      • o

        Pericarditis Following Myocardial Infarction

      • o

        Uremic Pericarditis

      • o

        Neoplastic Pericarditis

        • Tumor w/in pericarditis – usually from metastatic spread… usually large and hemorrhagic and can lead to cardiac tamponade.

      • o

        Radiation-induced Pericarditis

      • o

        Pericarditis Associated with Connective Tissue Disease

      • o

        Drug Induced Pericarditis

PATHOLOGY

  • Serous Pericarditis – early inflammatory response; exudate is thin fluid w/ scant leukocytes

  • Serofibrinous pericarditis – most common; plasma proteins in exudates Æ “bread and butter” pericarditis; portions of the pericardium may become thickened and fused… may lead to scar that restricts diastolic filling of heart

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