RT Book, Section
A1 Sorajja, Paul
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107717617
T1 Pericardial Disease
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessmedicine.mhmedical.com/content.aspx?aid=1107717617
RD 2024/04/20
AB The  diagnosis  of  acute  pericarditis  should  be  made  on  the  basis  of  typical  chest  pain  symptoms,  the  presence  of  a  pericardial  friction  rub,  and  electrocardiographic  abnormalities,  which  are  distinctive  from  changes  due  to  myocardial  ischemia.Although  a  comprehensive  evaluation  is  usually  warranted  in  patients  with  acute  pericarditis,  the  diagnostic  yield  is  low  with  causes  identified  in  less  than  20%  of  patients.High-dose  nonsteroidal  anti-inflammatory  drugs  (NSAIDs)  and  adjunctive  colchicine  are  effective  medical  therapy  for  acute  pericarditis,  except  in  episodes  due  to  acute  coronary  syndromes  where  NSAIDs  are  contraindicated.Pulsus  paradoxus  is  a  bedside  finding  of  cardiac  tamponade  that  arises  from  compromise  in  left  ventricular  stroke  volume  during  inspiration  and  a  subsequent  fall  in  stroke  volume.Echocardiography  is  the  primary  diagnostic  modality  for  tamponade.  Signs  include  diastolic  inversion  or  collapse  of  the  right  atrium  and  right  ventricle,  ventricular  septal  shifting  with  respiration,  enlargement  of  the  inferior  vena,  and  respiratory  variation  in  transmitral  flow.In  patients  in  whom  invasive  monitoring  is  available  (eg,  Swan-Ganz  catheter)  cardiac  tamponade  manifests  as  blunting  or  absence  of  the  y  descent,  elevation  in  filling  pressures,  tachycardia,  and  reduced  cardiac  output.The  diagnosis  of  constrictive  pericarditis  can  be  made  with  echocardiography  in  most  patients,  with  invasive  catheterization  reserved  for  patients  in  whom  the  clinical  findings  and  noninvasive  studies  cannot  definitively  establish  the  diagnosis.