Disorders of the Pericardium
Pericardial sac contains lymph like fluid to lubricate heart surface.
Acute Pericarditis:
• can be due to acute myocardial infarction, infection (usually viral), trauma (chest wall injury), tuberculosis, neoplasm or immunological reaction (eg SLE)
• clinically – sharp constant retrosternal pain that radiates to shoulders and neck, aggravated by breathing; maybe worse when lying on left side or on swallowing; pericardial friction rub may be heard
• management – pain helped with aspirin; NSAID’s and corticosteroids for inflammation; treat cause
Pericardial effusion:
• accumulation of fluid in pericardial sac; can be caused by same causes of pericarditis
• clinical features – sensation of retrosternal oppression; symptoms of left or right heart failure
Cardiac tamponade:
• acute heart failure due to large/rapid effusion
Chronic constrictive pericarditis:
• progressive thickening, fibrosis and calcification of pericardium
• usually after tuberculous pericarditis – but also occurs in rheumatoid arthritis
• clinically – fatigue, rapid pulse (also low volume), atrial fibrillation, peripheral oedema, loud and early third heart sound, fall in blood pressure during inspiration, ascites, Kussmaul’s sign, hepatomegaly
• management – surgical resection
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