1. Pericarditis By Dr. Hanan Said Ali

2. L EARNING OBJECTIVES Define pericarditis. Identify causes of pericarditis. Enumerate signs and symptoms of disease. Explain how to diagnose the case. Discus the Principles of care.

3. P ERICARDITIS Definition Pericarditis is inflammation of the pericardium due to a variety of causes. Causes Infection: viruses ( coxsakie, echo) or TB. Myocardial infarction: either within 1-2 days. Malignancy Radiotherapy

4. P ERICARDITIS Causes Cont. Trauma ( including cardiac surgery) Uraemia Connective tissue disorders. Assessment ( signs & symptoms) Pain: usually presents as a sharp, constant central chest pain eased by sitting forward and worsened by deep inspiration.

5. It worsened by flexion, extension, or rotation of the spine, including the neck; by movements of the shoulders and arms; by coughing; or by swallowing.  It may radiate to the neck, arm, shoulder, or occasionally abdomen.  It is not related to food nor eased by nitrates.

6. P ERICARDITIS Assessment ( signs & symptoms) Cont. Auscultation: may reveal a pericardial friction rub; scratchy noise heard throughout the cardiac cycle caused by rubbing together of the inflamed surface. Raised jugular venous pressure.

7. P ERICARDITIS Physiological assessment ECG: classically reveals concave- upward ST segment elevation in all leads. Heart rate: tachycardia may be evident. Pyrexia may be present. ( Pericardial tamponade may present with signs of poor flow and right heart congestion, or with cardiac arrest)

8. P ERICARDITIS Investigations The chest x- ray ( and echocardiograph) usually reveals no abnormality unless a pericardial effusion or associated myocarditis is present. Fluid in the pericardial space may be visualized by echo. Calcification may be visible in longstanding tuberculous pericarditis.

9. P ERICARDITIS Principles of care Bed rest Anti- inflammatory agents such as indomethacin. Treatment of the cause wherever possible. Steroid are rarely indicated. Occasionally, surgery is needed when constrictive pericarditis causes haemodynamic compromise

10. The patient’s temperature is monitored frequently. Because sitting upright and leaning forward is the posture that tends to relieve pain, chair rest may be more comfortable. As the chest pain and friction rub abate, activities of daily living may resume gradually.

11. If the patient is receiving medications such as analgesics, antibiotics, or corticosteroids for the pericarditis, his or her responses are monitored and recorded.

12. Thank you