Subject 6 - Pericarditis
(4 hours)
Location:
Training Room, Chamber cardiology department, cardiac bed therapeutic departments, cardiac
surgery clinic, ICU cardiology department.
Objective:
To know:
1. Clinical implications of the various options pericarditis.
2. Criteria for diagnosis of pericarditis.
3. Laboratory and instrumental manifestations of the disease.
4. The main manifestations of diseases which should be differentiated pericarditis.
Be able to:
• State the main clinical diagnosis and its complications.
• Perform differential diagnosis of myocarditis, cardiomyopathy and others.
• Make a plan of treatment.
• Provide emergency care for cardiac tamponade.
Professional orientation of students:
Pericarditis is one cause of heart failure in cardiology practice, they are recorded in 0.1% of
cases, their frequency according to the autopsy is about 5% of men suffer 1.5 times more often
than women. Timely detection of pericarditis creates conditions for active treatment and
preventive measures that prevent the development of decompensation and cardiac tamponade
formation and contributes to disability of patients.
Basic knowledge and skills.
№
Discipline
To be able to know
To be able to do
1
Anatomy
The anatomical structure of the heart
2
Histology
The structure and operation of the
pericardium
3
Biochemistry
Fundamentals of myocardial
metabolism and contraction of the
heart muscle
4
Pathophysiology
Mechanisms of inflammation: the
formation fluid.
5
Propedevtika
internal diseases
Semiotics impression pericardium
Evaluate the clinical and
laboratory studies
6
Microbiology
The etiology of pericarditis
Diagnosis of viral and
bacterial infections
Plan for practical lesson
№
Elements of practical employments
1.
Verification of present's students
Time(minutes)
5
2.
Entrance control and his analysis
15
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
5.
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical issues addressed in class
1. Clinical implications of the various options pericarditis .
2. Criteria for diagnosis of pericarditis .
3. Laboratory and instrumental manifestations of the disease .
4. The main diseases which should be differentiated pericarditis.
Methods of practical work:
The first lesson the teacher carries out safety training (if any condition), which is celebrated in
the magazine signed by the student teacher .
After reviewing the present teacher carries out a written entrance control basic knowledge
(attached set of 15 tests by the number of students : a dozen, subgroup, group). Then the
instructor carries out the distribution of students for Supervision of patients and determine their
problem.
№ Task
Instructions a student
Note teacher for
students
1.
In a survey reveal:
Pay particular attention
to the auscultatory
pattern of dry
pericarditis
To provide curation of
patient with
pericarditis, evaluate
test results, write
clinical diagnosis,
evaluation and
treatment plan (with
extract recipes)
1. Signs of heart failure
2. Increase the size of the heart
3. Characteristic ECG changes in
pericarditis, renthendoslidzhenni,
echocardiography
Teachers work according to the plan of studies, spend the weekend at the end of the control
knowledge. A set of original material for added control (situational and clinical problems, x-rays,
tests, etc.).. Before the end of class the teacher brings its results with the evaluation of each
student and announces the theme of the next session.
Forms and methods of self-control
Tests (input):
1. Leading risk factors for acute pericarditis include:
A. presence of infection
B. acute myocardial infarction
C. metabolic
D. autoimmune diseases
E. all these reasons
2. What is the position of the patient most characteristic in exudative pericarditis:
A. horizontal
B. vertical
C. horizontal with increasing head end
D. sitting, with fixation of the shoulder girdle
E. sitting with forward body bias
3. The most common complaint of patients with acute pericarditis include:
A. expiratory dyspnea
B. frequent non-productive cough
C. intense pain in the heart area
D. inspiratory dyspnea
E. cough with sputum
4. When held percussion the heart in patients with exudative pericarditis observed :
A. extension of absolute cardiac dullness
B. expansion relative dullness of the heart
C. sovpadinnya both absolute and relative dullness of heart
D. reduce absolute dullness of heart
E. reduce the relative dullness of the heart
5. The most complete picture of auscultation of acute pericarditis include:
A. muffled heart tones
B. pericardial friction noise
C. systolic murmur at the apex of the heart
D. diastolic murmur at the apex of the heart
E. systolic murmur at Botkin – Erb
6. What configuration cardiac shadow in X-ray surveys are the most typical in exudative
pericarditis :
A. spherical (trapezius muscle)
B. mitral
C. aortic
D. tricuspid
E. of the " hourglass "
7. What is the minimum amount of fluid in the pericardial cavity may be detected with
echocardiography study:
A. 20-30 ml
B. 50-100 ml
C. 150-200 ml
D. 250-300 ml
E. more than 300 ml
8. What are the most typical clinical signs of cardiac tamponade in:
A. common cyanosis
B. cutting asthma
C. swelling of the neck veins
D. Increase and tenderness of the liver
E. all these reasons
9. X-ray phenomenon of "armored heart" characterized by:
A. acute pericarditis
B. exudative pericarditis
C. chronic adhesive pericarditis
D. chronic constrictive pericarditis
E. idiopathic pericarditis
10. Which method of treatment is most effective in constrictive pericarditis:
A. antibiotics
B. appointment of non-steroidal anti-inflammatory drugs
C. purpose corticosteroids
D. holding pericardiocentesis
E. holding pericardiectomy
Tests (source ):
1. Patient A., 28 years, complains of breathlessness, pain in the heart, weakness, increased
temperature to 38,8 C. The disease fully binds with transferred 10 days ago pneumonia.
Objectively: of skin pale, cyanosis of the lips. BP-110/70 mmHg , BH -24 for 1 min. In light vesicular breathing . The boundaries of the heart are not common , muted tones in the III-IV m /
d at the left sternal border - systolic - diastolic murmur , which is soft timbre. HR = PS = 98 for 1
min. Liver + 1 cm. Blood test: leukocytes -11.5 x 10 9 / l, erythrocyte sedimentation rate - 38
mm/ h. Specify the most suspicion diagnosis?
A. Acute fibrinous pericarditis
B. Infectious-allergic myocarditis
C. Rheumatic heart defect
D. Acute pleurisy
E. exudative pericarditis
2. Patient B., 35years , complain of breathlessness with little exertion. Rheumatism and angina
was sick . Objectively: he swelling of the neck , the boundaries of the relative dullness of the
heart is normal . In the lungs: marked congestion wheezing , BH -26 for 1 min. , HR = PS = 96
for 1 min .. Liver + 3 cm no peripheral edema . Blood test were normal. ECG sinus rhythm, low
voltage teeth in all leads. On radiographs, trapezius shadow heart. What is the most suspicion
diagnosis for a patient?
A. Myxoma heart
B. Constrictive pericarditis
C. exudative pericarditis
D. Hypertrophic cardiomyopathy
E. Dilated cardiomyopathy
3. The patient S., 39 years , complains of marked dyspnea, pain in the heart area . The disease
fully binds transferred from 2 weeks ago flu. Objectively: sitting position with the trunk bent
forward. Puffy face, cyanotic, marked swelling of the veins of the neck. The boundaries of the
heart are common to both sides, tone deaf. HR = PS = 118 for 1 min. BP-90/60 mmHg , liver + 4
cm. Blood test: erythrocyte sedimentation rate -45 mm / h . The ECG -low voltage teeth in all
abductions. On radiographs, trapezius shadow heart. What is the most suspicion diagnosis for the
patient?
A. Viral myocarditis
B. CHD
C. Exudative pericarditis
D. Dilated cardiomyopathy
E. Rheumatic valvular insufficiency
4. Patient , 42 years, complains of constant pain in the heart, increasing temperature to 37,5 C
every night. Ill a week ago after transferred cold. Objectively: HR = PS = 92 for 1 min., BP120/80 mmHg. The boundaries of the heart is normal, cardiac sounding in systole and diastole
listen "scraping noise." Blood test: leukocytes - 9,6 x 10 9 / l, erythrocyte sedimentation rate – 25
mm/h . The ECG - ST-segment elevation in standard abductions. Indicate the most suspicion
diagnosis?
A. Subepicardial myocardial infarction
B. Myocarditis
C. Bacterial endocarditis
D. Dry pericarditis
E. Rheumatoid endomyocarditis
5. Patient K., 50 years, complained of a dull pain in the heart, breathlessness, increased
temperature to 38,3 C. Two weeks ago suffered a severe pneumonia. Objectively: HR = PS =
104 for 1 min., BP-90/60 mmHg, RR = 24 for 1 min. Cardiac deaf. The ECG-voltage decline, the
ST segment elevated above the contours in all leads. On radiographs, shadow hearts expanded in
all directions, heartbeat of small amplitude. What is the most suspicion diagnosis for the patient?
A. Angina
B. Infectious myocarditis
C. Dilated cardiomyopathy
D. Rheumatic heart defect
E. Exudative pericarditis
Situational tasks
1. After a long subfebrile patient observed enhancement of breathlessness, pain in right
hypochondrium, swelling of the legs. Objectively: swelling of the neck it , HR = PS = 112 for 1
min. Sometimes disappears in the phase of inspiration is stated, RR = 26 for 1 min. Cardiac
dramatically weakened . The ECG - reducing voltage spikes, the X-ray shadow - heart expanded,
rounded shape. What is the most suspicion diagnosis? What additional research is necessary to
assign ? Your treatment in patient?
2. Patient M., 35 years, complains of constant pain in the heart, increasing temperature to 37,3 C,
ill 10 days ago after suffering flu. Objectively: HR = PS = 88 for 1 min. RR = 18 for 1 min. BP130/80 mmHg Borders with hearts of essential changes, sonorous tones during systole and
diastole listen "scraping" noise. Blood test: leukocytes - 10,6 x 10 9 / l, erythrocyte
sedimentation rate -32 mm/h. What is the most suspicion diagnosis? What additional research is
necessary to assign ? Your therapeutic approach?
Illustrative material
● a set of clinical and biochemical
● set of radiographs
● set of ECG
● Data echocardiographic studies
● CT or MRI data.
Sources of information
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
Individual Students Program topics
Explore:
• Key provisions of the pathogenesis, classification, current methods of diagnosis and treatment
of pericarditis.
Be able to:
• Conduct clinical examination, make a plan of examination of patients with pericarditis.
Pay attention: in the differential diagnosis of diseases that occur with the syndrome perikardytu
(CHF, tuberculosis, SLE, SNIL et al.).