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Common Congenital Heart Lesions - page 80 / 126

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80 of 126 TREATMENT PLAN for ACUTE PERICARDITIS

  • 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.

TREATMENT PLAN for PERICARDIAL EFFUSION

  • If cause of effusion is known, get rid of cause

  • If cause is unknown, clinical state determines whether or not to do a pericardiocentises

  • If asymptomatic, even large volume could be observed for years…

  • But if there is a sudden rise in pericardial volume or cardiac compression is seen, then do

a pericardiocentises (drain the pericardium).

TREATMENT PLAN for CARDIAC TAMPONADE

  • Pericardiocentises is the only intervention that can save the patient’s life.

    • o

      Patient is head up at 45 deg angle, needle inserted into pericardial space below xiphoid process… catheter inserted into pericardial space and another catheter into right side of heart… both hooked up to a transducer for pressure readings

      • o

        In tamponade, intrapericardial and diastolic intracardiac pressures will be high and equal… after pericardiocentesis, pericardial pressure goes to normal and is no longer equal to pressures w/in heart (which also decline to normal levels)

      • o

        Can repeat procedure if tamponade recurs

  • Sometimes you may need to remove part or all of the pericardium (surgery) to prevent reoccurances…

TREATMENT PLAN for CONSTRICTIVE PERICARDITIS

  • Only effective treatment is surgical removal of the pericardium

    • o

      Symptoms may not resolve immediately but eventually they improve in majority of pts.

      • o

        Also make sure that prior to this, you have ruled out restrictive cardiomyopathy which can have very similar presentations… (do myocardial biopsy)

*** all these treatment plans are also located in the outline w/ their respective diseases… I just cut and pasted them here for easier reference as they specifically have to do with the last objective for the reading…

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