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Common Congenital Heart Lesions - page 72 / 126

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72 / 126

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  • Suppurative (purulent) pericarditis – intense inflammatory response (most assoc with

bacterial infection)

  • Heorrhagic pericarditis – grossly bloody form due to TB or malignancy

PRESENTATION

  • Chest pain and fever!

  • Differentiate from MI b/c pain is sharp and pleuritic (meaning aggravated by inspiration

and coughing) and positional (sitting and leaning forward make it feel better)

  • May have dyspnea but not exertional -- usually b/c it just hurts to breathe deeply

PHYSICAL EXAM

Friction

rub Æ scratchy sound from inflamed layers moving against eachother (heard

best with diaphragm and patient leaning forward while exhaling) Rub is evanescent Æ comes and goes from one exam to the other

TESTS and IMAGING

  • ECG Æ abnormal in 90%

    • o

      diffuse ST segment elevation in most leads except aVR and V1

      • o

        PR segment depression (pg 315 for good examples)

      • o

        Contrast to MI where ST segments only elevated in leads overlying infarction and no PR depression

  • Echocardiography Æfor presence and hemodynamic significance of pericardial effusion

  • Additional studies for finding cause (like PPD, serology, search for malignancy, etc)

TREATMENT

  • Idiopathic/viral usually self limited Æ rest and pain relief w/ NSAIDs (not steroids)

  • Pericarditis after MI also treated similarly w/ rest and aspirin (try to stay away from

other NSAIDs b/c delays healing of MI)

  • Purulent pericarditis needs drainage and intensive antibiotic therapy.

Pericardial Effusion

Normally only 15-50 mL of pericardial fluid… more may accumulate in assoc w/ above types of pericarditis or also noninflammatory serous effusions may occur

PATHOPHYS

  • So whether you get cardiac compression symptoms depends on:

    • o

      Volume of fluid

      • o

        Rate of fluid accumulation

      • o

        Compliance characteristics of pericardium

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