Acute Pericarditis |
- Sharp, pleuritic chest pain, worse on inspiration or lying flat
- Pericardial friction rub on auscultation
- Relief with sitting up and leaning forward
- Low-grade fever, dyspnea
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- ECG: widespread ST elevation and PR depression
- Echocardiogram: may show pericardial effusion
- Blood tests: elevated inflammatory markers (ESR, CRP)
- Viral serology or autoimmune panel if needed
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- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Colchicine to reduce recurrence
- Corticosteroids in severe or refractory cases
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Pericardial Effusion |
- Dull chest pain, dyspnea
- Soft heart sounds, reduced friction rub
- Symptoms of tamponade in large effusions (hypotension, distended neck veins)
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- Echocardiogram: confirms presence of fluid
- Chest X-ray: enlarged cardiac silhouette ("water-bottle heart") in large effusions
- ECG: low voltage QRS complexes
- Pericardiocentesis for diagnostic fluid analysis if needed
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- Observation if small and asymptomatic
- Pericardiocentesis if symptomatic or large
- Treatment of underlying cause (e.g., infection, malignancy)
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Cardiac Tamponade |
- Beck's triad: hypotension, distended neck veins, muffled heart sounds
- Pulsus paradoxus (exaggerated drop in blood pressure during inspiration)
- Tachycardia, dyspnea, shock
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- Echocardiogram: shows effusion with diastolic collapse of the right atrium or ventricle
- ECG: low voltage QRS and electrical alternans (alternating QRS amplitude)
- Chest X-ray: enlarged cardiac silhouette
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- Emergency pericardiocentesis
- Intravenous fluids to maintain blood pressure until drainage
- Treatment of underlying cause (e.g., malignancy, infection)
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Constrictive Pericarditis |
- Chronic dyspnea, fatigue
- Right heart failure signs: ascites, peripheral edema, jugular venous distension
- Kussmaul’s sign: paradoxical rise in JVP with inspiration
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- Echocardiogram: thickened pericardium, diastolic dysfunction
- CT or MRI: pericardial thickening and calcification
- Cardiac catheterization: shows equalization of diastolic pressures in all chambers
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- Diuretics to manage fluid overload
- Pericardiectomy (surgical removal of the pericardium) in severe cases
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