Pericarditis

Febrina Rambu
C 111 11 162
Pembimbing :
dr. Akhtar Fajar M, SpJP, FIHA
DIBAWAKAN DALAM RANGKA TUGAS KEPANITRAAN
KLINIK
BAGIAN KARDIOLOGI DAN KEDOKTERAN VASKULAR
FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN

Anatomy
Normal amount of
pericardial fluid: 2550 cc
Two layers:
Outer layer is the
parietal pericardium
and consists of layers
of fibrous and serous
tissue
Inner layer is visceral
pericardium and
consists of serous
tissue only

Pericardium
Fibroelastic sac
consisting of 2
layers
Visceral at
epicardial side
Parietal at
mediastinal
side
Pericardial fluid
formed from
ultrafiltrate of
plasma

Epidemiology Pericarditis
0.1% of hospitalized patients
5% of patients admitted to
Emergency Department for nonacute myocardial infarction chest
pain
1% pericarditis patient is subclinical

Pericarditis is
inflammation of
pericardial layer of
the heart, with or
without fluid
acumulation in
percardial space

Classification
ACUTE PERICARDITIS (less
than 6 weeks) : fibrousa and
efusif
SUB-ACUTE PERICARDITIS (6
weeks

6
months)
:
Constrictive
and
efusiveconstrictive
CHRONIC
(more than
constrictive,
adhesive

PERICARDITIS
6 months) :
efusive,
and

INFECTIOUS PERICARDITIS :
virus, piogenic, tuberculosis,
mikotik, etc
NON-INFECTIOUS
PERICARDITIS : infarc
myocard acute, uremia,
neoplasma, miksedema,
cholestrol, trauma, acute
idiopatik, etc.
PERICARDITIS CAUSED BY
HYPERSENSITIVITY OR
AUTOIMUN : rematic fever,
colagen vascular disease,
drug-induced, sindrom
Dressler.

ACUTE PERICARDITIS
The most common affliction of pericardium
Refers to inflammation of its layers
ETIOLOGY :
INFECTIOUS :
Idiopathic and viral pericarditis
Tuberculosis pericarditis
Nontuberculosis bacterial pericarditis
NON-INFECTIOUS :
Pericarditis following Myocardial
Infarction
Uremic Pericarditis
Neoplastic Pericarditis
Radiation-induced pericarditis
Pericarditis associated with connective
tissue disease

Characterized by three stages:

1.LOCAL VASODILATION WITH TRANSUDATION OF
PROTEIN-POOR, CELL-FREE FLUID INTO
PERICARDIAL SPACE
2.INCREASED VASCULAR PERMEABILITY leak of
protein to pericardial space
3.LEUKOCYTE EXUDATION by neutrophils
mononuclear cells

PATHOLOGY
SEROUS PERICARDITIS

represents

the early inflammatory response common to

all types of acute pericarditis

SEROFIBRINOUS PERICARDITIS
SUPPURATIVE (or purulent)
PERICARDITIS
HEMORRHAGIC PERICARDITIS

CLINICAL FEATURES

AUSCULTATION : sound
A SCRATCHY
PERICARDIAN
FRICTION RUB

In its full form, the rub

consist 3 components,
corresponding to the phases
of greatest cardiac movement
:
Ventricular contraction
Ventricular relaxation

Diagnosis of Pericarditis:
Presence of two of the following necessary
1) Chest pain
Sudden onset
localized to anterior chest wall
pleuritic
sharp
Positional: may improve if pt leans
forward, worse with lying flat
2) Cardiac auscultation: Pericardial friction rub
Present in up to 85% of pts with
pericarditis without effusion
friction of the two inflamed layers of
pericardium, typically triphasic rub,
heard with diaphragm of stethoscope at
left sternal border
3) Characteristic ECG changes
4) Pericardial effusion

LABORATORIUM :
serum transaminase till 80
unit. CKMB not raise

RADIOLOGY :
Normal in patients with acute pericarditis unless
pericardial effusion is present
Enlarged cardiac silhouette Requires 200cc of
fluid

TREATMENT
Treat underlying disease
Bed rest
Analgesic
Anti-inflamation
Colchicine recurrent
pericarditis or resistent
NSAID and chorticosteroid

CHRONIC PERICARDITIS

CONSTRICTIVE PERICARDITIS
Abnormalities occur during diastole; systolic
contraction of the ventricles is usually normal
Clinical features : fatigue, hypotension, reflex
tachycardia, jugular venous distention,
hepatomegaly with ascites, and peripheral edema

ADHESIVE PERICARDITIS

Chronic pericarditis with adhesion between parietal

and visceral pericardium
Mostly seen in rheumatic disease

Chest Radiograph
Echocardiographic
CT-scan
Cardiac catheterization