Snapshot A 58-year-old woman with a past medical history of systemic lupus erythematosus presents to the emergency room for sharp chest pain. She reports that it is worse with inspiration and gets better when she leans forward. On physical exam, there is a friction rub that is loudest when she leans forward. An electrocardiogram shows widespread ST elevation. Introduction Clinical definition inflammation of the pericardium characterized by sharp pain worsened by inhalation Etiology serous autoimmune disease systemic lupus erythematosus rheumatoid arthritis uremia viral illness coxsackievirus fibrinous pericarditis complication of myocardial infarction (MI) 1-3 days after and several weeks after (Dressler syndrome) the MI systemic lupus erythematosus uremia rheumatic fever hemorrhagic tuberculosis malignancy constrictive radiation therapy viral illness tuberculosis Pathogenesis inflammation of the pericardium can cause chest pain movement of the heart can cause friction between the 2 pericardial layers, producing a friction rub inflammation may cause a pericardial effusion Prognosis can be acute or chronic, and may recur viral pericarditis is usually self-limited Presentation Symptoms sharp pleuritic chest pain that is worsened by inhalation pain is also relieved by sitting up and leaning forward shoulder pain (referred pain) pericarditis is innervated by phrenic nerve Physical exam may have a fever friction rub pathognomonic Kussmaul sign seen in constrictive pericarditis ↑ jugular venous distention on inspiration Imaging Echocardiography indication to assess for pericardial effusion and cardiac tamponade Radiography indication to rule out pneumonia or other pulmonary pathology findings constrictive pericarditis may have pericardial calcifications on radiography Studies Labs ↑ erythrocyte sedimentation rate ↑ C-reactive protein may have ↑ troponin I Electrocardiogram (ECG) PR segment depression in most leads except aVR where the reflections are opposite of all other leads lead II may show the most pronounced depressions leep <a target="_blank" href="https://www.medbullets.com/step1-stats/1030/sleep" rel="nofollow">www.medbullets.com/step1-stats/1030/sleep</a> widespread ST segment elevations upright T waves weeks after pericarditis, this will become inverted T waves classic ECG signs may be absent in uremic pericarditis Making the diagnosis based on clinical presentation and ECG findings Differential Cardiac tamponade distinguishing factor pulsus paradoxus and Beck triad on exam Myocardial infarction distinguishing factor more focal ST elevation on ECG suggestive of anatomic damage Treatment Conservative restriction of exercise indication for all patients Medical nonsteroidal anti-inflammatory drugs (NSAIDs) indication best initial therapy drugs indomethacin naproxen ibuprofen aspirin prednisone indication pain refractory to NSAIDs colchicine indication adjunct therapy to NSAIDs or steroids Non-operative pericardiocentesis indication in patients with pericardial effusion or cardiac tamponade dialysis indication for patients with pericarditis from uremia Complications Pericardial effusion and tamponade
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.CV.12.37) A 45-year-old African-American woman presents with dyspnea, cough, and non-radiating chest pain. Her chest pain is relieved by leaning forward and worsens upon leaning backwards. A scratchy rub is heard best with the patient leaning forward. Physical examination did not elucidate evidence of a positive Kussmaul's sign, pulsus paradoxus, or pericardial knock. The patient most likely is suffering from which of the following? Tested Concept QID: 100553 Type & Select Correct Answer 1 Cardiac tamponade 1% (1/96) 2 Constrictive pericarditis 15% (14/96) 3 Acute pericarditis 78% (75/96) 4 Libman-Sacks endocarditis 3% (3/96) 5 Acute myocardial infarction 1% (1/96) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (M1.CV.12.104) A 35-year-old Caucasian female with a history of rheumatoid arthritis presents to your clinic with pleuritic chest pain that improves while leaning forward. Which of the following additional findings would you expect to observe in this patient? Tested Concept QID: 100620 Type & Select Correct Answer 1 Increase in jugular venous pressure on inspiration 47% (90/192) 2 Exaggerated amplitude of pulse on inspiration 19% (37/192) 3 Pulsatile abdominal mass 3% (5/192) 4 Continuous machine-like murmur 7% (14/192) 5 S3 heart sound 16% (30/192) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.CV.12.209) A 34-year-old Caucasian female presents at the ER with fever and sharp pain in her chest upon coughing and inhalation. Three weeks earlier she presented to her rheumatologist with a butterfly rash, joint pain and fatigue and was given a diagnosis of systemic lupus erythematosus. A friction rub is present upon physical exam. Which of the following do you most suspect in this patient? Tested Concept QID: 100725 Type & Select Correct Answer 1 Pulmonary hypertension 0% (0/81) 2 Interstitial lung disease 0% (0/81) 3 Acute myocardial infarction 0% (0/81) 4 Pericarditis 98% (79/81) 5 Pericardial tamponade 1% (1/81) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (M1.CV.12.30) A 35-year-old African-American female presents to the emergency room complaining of chest pain. She also complains of recent onset arthritis and increased photosensitivity. Physical examination reveals bilateral facial rash. Which of the following is most likely to be observed in this patient? Tested Concept QID: 100546 Type & Select Correct Answer 1 Pain improves with inspiration 6% (9/148) 2 Pain relieved by sitting up and leaning forward 54% (80/148) 3 High-pitched diastolic murmur 15% (22/148) 4 Fixed and split S2 7% (10/148) 5 Mid-systolic click 15% (22/148) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept
All Videos (3) Login to View Community Videos Login to View Community Videos Pericardial Friction Rub Chris Battista Cardiovascular - Pericarditis D 6/27/2013 61 views (3) Login to View Community Videos Login to View Community Videos Pericardial Friction Rub Adam Widman Cardiovascular - Pericarditis D 5/19/2013 27 views (1) Login to View Community Videos Login to View Community Videos Echocardiogram - Pericarditis Derek Moore Cardiovascular - Pericarditis D 3/17/2013 49 views (1)