Pericarditis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

Pericarditis is a cardiac disorder where the pericardiac sac surrounding the heart and roots of the great vessels coming from the heart is inflamed.
Pericarditis is caused by:
A. Infections
1. Bacterial- streptococcus
2. Viral - cytomegalovirus, enterovirus, influenza virus, hepatitis B virus, adenovirus, and herpes simplex virus
3. Mycotic
4. Tuberculosis
B. Non- infection:
1. Autoimmune diseases include:
a. Rheumatic fever
b. Rheumatoid arthritis
c. Systemic lupus erythrematosis
d. Drug induced
2. Neoplastic
3. Uremia
4. Myxedema
5. Trauma
6. Myocardial infarction
7. Myocarditis,
8. Dissecting aortic aneurysm,
9. Radiation
Symptoms:
1. Chest pain of sudden onset in the anterior chest
2. Pain is sharp and becomes worse with inspiration due to pleural inflammation.
3. Pain is relieved with sitting up and leaning forward and become worse on lying down
4. Pericardial rub is a typical sign of acute pericarditis.
This rub is best heard at the left sternal border as a squeaky or scratching sound using the diaphragm of the stethoscope.
The pericardial rub is due to the friction generated by the two inflamed layers of the pericardium.
Diagnosis is by:
Classic feature of chest pain and dyspnea with pericarditis
ECG can be diagnostic in acute pericarditis and evolves in 4 stages.
Stage 1 accompanies the onset of acute pain
Stage 2 occurs several days later with the return of the ST segment to baseline
Stage 3 ECG changes are T waves become inverted in stage 3 but without Q-wave formation
Stage 4 ECG changes are the ECG returns to the prepericarditis baseline weeks to months after the initial onset
The T-wave inversion may persist indefinitely in the chronic inflammation observed with tuberculosis, uremia, or neoplasm
However, only 50% of patients with pericarditis experience all 4 stages.
An important ECG finding is PR-segment depression, which has been reported in as many as 80% of viral pericarditis cases.
MRI is sensitive for detecting pericardial effusion and loculated pericardial effusion and thickening.
Pericardiocentesis is relatively safe when guided by echocardiography, especially with large free anterior effusion
Treatments may include medicines and, less often, procedures or surgery.
Medical treatment are:
Antibiotics
NSAIDs
Surgical procedures for pericarditis include pericardiectomy, pericardiocentesis, pericardial window placement, and pericardiotomy.
Pericardiectomy is the most effective surgical procedure for managing large effusions, because it has the lowest associated risk of recurrent effusions
TABLE OF CONTENT
Introduction
Chapter 1 Pericarditis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Coronary Heart Disease
Chapter 8 Cardiomyopathy
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Feb 1, 2017
• ISBN: 9781370344703

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Pericarditis,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2015 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes the Pericarditis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Pericarditis)

This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Condition) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Conditions into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 700 amazon kindle books and some into Smashwords.com eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical conditions.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring you the latest information about a condition or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Pericarditis

What is Pericarditis?

Pericarditis is a cardiac disorder where the pericardiac sac surrounding the heart and roots of the great vessels coming from the heart is inflamed.

Who is at risk of Pericarditis?

1. Most common of all pericardial condition

2. More common in females than males

What is the cause of Pericarditis?

Pericarditis is caused by:

A. Infections

1. Bacterial- streptococcus

2. Viral - cytomegalovirus, enterovirus, influenza virus, hepatitis B virus, adenovirus, and herpes simplex virus

3. Mycotic

4. Tuberculosis

B. Non- infection:

1. Autoimmune diseases include:

a. Rheumatic fever

b. Rheumatoid arthritis

c. Systemic lupus erythrematosis

d. Drug induced

2. Neoplastic

3. Uremia

4. Myxedema

5. Trauma

6. Myocardial infarction

7. Myocarditis,

8. Dissecting aortic aneurysm,

9. Radiation

What are the Symptoms of Pericarditis?

Symptoms:

1. Chest pain of sudden onset in the anterior chest

2. Pain is sharp and becomes worse with inspiration due to pleural inflammation.

3. Pain is relieved with sitting up and leaning forward and become worse on lying down

4. Pericardial rub is a typical sign of acute pericarditis.

Absence of this sign does not mean that it is not pericarditis.

This rub is best heard at the left sternal border as a squeaky or scratching sound using the diaphragm of the stethoscope.

The pericardial rub is due to the friction generated by the two inflamed layers of the pericardium.

5. Fever may be present.

How is diagnosis of Pericarditis made?

Diagnosis:

1. History and physical examination

a. Chest pain,

b. Pericarditis episodes

2. Blood tests:

a. A Full Blood Count may show an elevated white count.

b. Serum C-reactive protein may be elevated.

c. Increase in serum creatine kinase MB and cardiac troponin I ( both of which are also markers for myocardial injury.

3. Electrocardiogram

ECG changes in acute pericarditis show inflammation of the epicardium (the layer directly surrounding the heart).

Typical ECG changes in acute pericarditis are:

Stage 1 -- Diffuse positive, ST elevations with reciprocal ST depression in aVR and V1.

Stage 2 – There is normalization of ST and PR deviations

Stage 3 -- Diffuse T wave inversions

Stage 4 -- ECG becomes normal OR T waves may be indefinitely inverted

4. Echocardiography

It is usually normal in acute pericarditis.

It can show the presence of pericardial effusion, the presence of which supports the diagnosis.

5. Chest X-ray

Chest X-ray is usually done if a pulmonary cause of Pericarditis is indicated.

It is normal in acute pericarditis, but can reveal cardiomegaly (enlarged heart) if the pericardial effusion is more than 200 mL.

6. Cardiac cauterization –

Coronary angiography in those patients usually shows the presence of normal vascular perfusion.

7. Pericardial fluid examination and biopsy-

It is rarely done except for confirmation of neoplasm and tuberculosis.

What is the Complication of Pericarditis?

Complication:

The collection of fluid in the pericardial space to cause blockage to the inflow of blood to the heart is called cardiac tamponade.

Cardiac tamponade is an emergency and must be treated urgently.

What is the Treatment of Pericarditis?

Treatment:

A heart specialist can treat on outpatient basis patients with acute pericarditis which is not complicated.

A. Those with high risk factors will need to be admitted to hospital:

1. Sudden onset

2. High fever

3. Leukocytosis

4. Presence of cardiac tamponade

5. Large pericardial effusion (echo-free