Description
Pericarditis is an inflammation of the pericardium.Pericarditis is acute in nature and may last for several months.In this condition,the membrane in heart is red and swollen,sometimes there can be extra fluid in the space between the pericardial layers,which is called pericardial effusion.
Today our guest speaker is going to tell us about the management of pericardial disease through the cases he managed.
Summary Listen
- The speaker discusses pericardial diseases, specifically pericarditis, pericardial effusion, and constrictive pericarditis, illustrating them with case examples. They emphasize the importance of echocardiography in diagnosis, including parameters like LVOT, RV, and the identification of echolucent spaces indicative of fluid accumulation. The normal thickness of the pericardium is highlighted, along with how it thickens in constrictive pericarditis. The pericardium's role in allowing heart expansion, preventing excessive enlargement, and guarding against infection is also covered.
- Causes of pericardial diseases are categorized as infectious, iatrogenic, immune-mediated, and miscellaneous. Common infectious causes include tuberculosis and viral infections. Iatrogenic causes involve post-cardiac surgery and radiation. Immune-mediated causes include systemic lupus and rheumatoid arthritis. Idiopathic causes are also mentioned.
- Pericardial effusion is defined as an abnormal accumulation of fluid within the pericardial space, typically exceeding the normal range of 15-50 ml. The rate of fluid accumulation, rather than just the volume, is crucial. A rapid accumulation of even a small amount of fluid can cause cardiac tamponade due to the pericardium's non-compliance. The speaker explains how cardiac tamponade occurs when intra-pericardial pressure equals the pressure in the cardiac chambers, impeding cardiac filling.
- Methods for quantitating pericardial fluid include semi-quantitative estimations based on echo-free space measurements. The Druise method is also mentioned, utilizing an ellipse formula and measurements from echocardiographic views. CT-guided formulas offer another approach. The speaker stresses that the rate of effusion accumulation is more clinically significant than the total volume.
- Cardiac tamponade, a hemodynamic consequence of pericardial fluid accumulation, is described. Hemodynamic signs include equalization of right atrial, right ventricular diastolic, and pulmonary artery diastolic pressures. Echocardiographic signs include diastolic collapse of the right ventricle.
- Constrictive pericarditis, characterized by restriction of ventricular filling due to a thickened pericardium, is discussed. Doppler characterization includes a restrictive pattern with an E/A ratio greater than 1.5. Respiratory variations in Doppler patterns across cardiac valves and hepatic veins are key diagnostic indicators. In inspiration, increased flow from the IVC to the RA shifts the interventricular septum into the LV.
- The speaker describes an M-mode echocardiographic finding of constrictive pericarditis. During inspiration, posterior motion of the interventricular septum occurs into the LV cavity. In expiration, the interventricular septum moves anteriorly into the RV. Respiratory variation of the mitral wave is also analyzed. A 25% increase in mitral velocity with expiration is important in diagnosis.
- A case study is presented of a patient initially diagnosed with cryptogenic cirrhosis and planned for liver transplant. Echocardiographic findings of a jerky interventricular septum, dilated IVC, and respiratory variations across valves led to a diagnosis of constrictive pericarditis. The patient then underwent pericardiectomy. Advanced echocardiographic techniques like tissue Doppler and strain imaging, used for differential diagnosis from restrictive cardiomyopathy, were also discussed.
Sample Certificate
About the Speakers
Dr. K.K. Kapur
Alumni- Postgraduate Institute of Medical Education and Research
Financial Disclosure
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