PERICARDITIS

CITRA KRISTI MELASARI I4061152063

PUTRI ANGGANA DEWI I4061152065

S YA H R I N A FA K I H U N I4061161028

MUHAMMAD ANUGERAH PERDANA I4061162015

J U W I TA V A L E N R A M A D H A N I A I4061171009

W E N N I J U N I A R N I T R I PA N I I4061171013

B U A N A D E WA N T I W I M P I I4061172047

Preceptor:
Letkol (CKM) dr. Prihati Pujowaskito, Sp. JP (K), MMRS

Cardiology Department Dustira District Hospital

Faculty of Medicine Tanjungpura University
2018
 Anatomy

Shabetai R. The Pericardium. Netherlands: Kluwer Academic Publisher; 2013. p. 1-5.

Definition
Pericarditis is an inflammation of parietal pericard,
visceral pericard or both

It has various inflammation respond such as pericardial

effusion, fibrin deposition, fibrous tissue proliferation,
granuloma or calcification
Darsee R. Diseases of the pericardium. In: Braunwald E, Ed. Heart disease. New York: Saunders Publishing
Co; 1987. p. 1415-8.
 Etiology

Tingle LE, Molina D, Calvert CW.

Acute pericarditis. American family
physician. 2007;76(10):1509-14.
Physiology pericardium
there are about 5 to 10 cc of serous fluid that serves to lubricate the
movement, while providing space for the heart muscle
the visceral pericardium, this part is thinner and more flexible,
making it easier for the heart to move
the parietal pericardium, this part tends to be thicker and harder, so
it can protect the heart from external collisions and also withstand
an enlarged heart volume when there is excess blood in the heart.
Pathophysiology: Disorders of
pericardium
 Diseases of pericardium
Diseases of the pericardium present clinically in one of four ways :
1. Acute and recurrent pericarditis
2. Pericardial effusion without major hemodynamic
compromise
3. Cardiac tamponade
4. Constrictive pericarditis
Note: AP refers to inflammation of the pericardial sac.
The term myopericarditis, or perimyocarditis, is used for cases of AP that also
demonstrate myocardial inflammation
Classification
Clinical Classification
Etiologic Classification
Pericarditis: Chest Pain
• Sudden in onset
• Retrosternal in location
• Pleuritic and sharp in nature
• Exacerbated by inspiration and coughing
• Worsens when supine and improves upon sitting upright or leaning
forward.
• Can often radiate to the neck, arms, or left shoulder, trapezius muscle.
Diagnostic test in pericarditis
Initial evaluation includes:
1. A clinical history and physical examination
2. ECG
3. Echocardiography
4. Chest radiography, and
5. Lab studies.
Sign and symptoms

Chest pain is the cardinal symptom of pericarditis, usually precordial

or retrosternal with referral to the trapezius ridge, neck, left
shoulder, or arm.
Low-grade intermittent fever, dyspnea/tachypnea (a frequent
complaint and may be severe, with myocarditis, pericarditis, and
cardiac tamponade), cough, and dysphagia.
In tuberculous pericarditis, fever, night sweats, and weight loss are
commonly noted (80%).
Physical examination

vital sign : blood pressure decreases, fast pulse

Inspection : weakness, pain, anxiety, tightness
Palpation : chest pain
Auscultation: pericardial friction rubs
 Pericardial Friction Rub
• Present in 85% of cases of pericarditis
• Highly specific with a variable sensitivity
• A high-pitched scratchy or squeaky sound best heard with the diaphragm at the LSB with the
patient leaning forward.
• Has 3 components, which correspond to atrial systole, ventricular systole, and early
diastole.(1)
• Pericardial friction rub is audible throughout the respiratory cycle, whereas the pleural rub
disappears when respirationsare on hold.
Ref 1. Spodick DH. Pericardial rub. Prospective, Multiple observer investigation of pericardial friction in100
patients. Am J Cardiol 1975; 35:357.
Pericardial rub Sound
 ECG findings with pericarditis
• Stage 1 (1st hrs-dys) :characterized by diffuse ST elevation (typically concave up).
• Stage 2(1st wk): characterized by normalization of the ST & PR segments.
• Stage 3: diffuse T wave inversions.
• Stage 4 :normalization of the ECG or indefinitepersistence of T wave inversions.
• Typical ECG evolution in AP has been shown in up to 60% of pts in a
clinical series,(1) & stage 1 changes have been observed in 80% of pts with
pericarditis.(2)
1. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol.
2004;43(6):1042-1046.

2. Bruce MA, Spodick DH. Atypical electrocardiogram in acute pericarditis:characteristics and prevalence. J Electrocardiol.1980;13(1):61-66.
Electrocardiogram (ECG) in pericarditis
ECG ; AMI Vs Pericarditis
 IMAGING
Echocardiography is indicated if pericardial effusion is suspected on
clinical or radiographic grounds, the illness lasts longer than 1 week,
or myocarditis or purulent pericarditis is suspected.

A chest radiograph is helpful to exclude pulmonary conditions that

may be responsible for or are associated with the cause of
pericarditis (ie, cancer, infection, SLE, sarcoidosis, etc).
Chest radiographs revealing markedly enlarged cardiac silhouette
and normal-appearing lung parenchyma in prepericardiocentesis
(A) and postpericardiocentesis (B). Courtesy of Zhi Zhou, MD.
 Laboratory tests
Laboratory tests may include:
CBC;
serum electrolyte, blood urea nitrogen (BUN), and creatinine levels;
erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels; and
cardiac biomarker measurements, lactate dehydrogenase (LDH), and serum
glutamic-oxaloacetic transaminase (SGOT; AST) levels.
Serum titers for suspected infectious etiologies and testing for tuberculosis
exposure (ie, PPD or interferon-gamma release assays) may be helpful.
Treatment pericarditis
Treatment pericarditis
Pericarditis associated with myocardial involvement (myopericarditis)
Treatment pericarditis
Pericardial effusion
Treatment pericarditis
Viral pericarditis
Treatment pericarditis
Bacterial pericarditis
Conclusion
Pericarditis is inflammation of the parietal, visceral pericardium or both, which
shows a variable inflammatory response such as pericardial effusion, fibrin
deposition, fibrous tissue proliferation, granuloma formation, or calcification.
Pericarditis is most commonly caused by viral infections, other causes are also
caused by bacterial infections such as TB, uremic pericarditis, heart attacks,
cancer, autoimmune disorders, and chest trauma.
The prognosis in each individual with pericarditis depends on the etiology,
presence of pericardial effusion and / or tamponade, and appropriate initial
management.