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Showing posts with label Constrictive pericarditis. Show all posts
Showing posts with label Constrictive pericarditis. Show all posts

How common is pericardial rub in constrictive pericarditis ?

How common is pericardial rub in constrictive pericarditis ? 

It is not heard in constrictive pericarditis.
How common is pericardial rub in constrictive pericarditis ? 

It is not heard in constrictive pericarditis.

How would you treat a patient with constrictive pericarditis ?

How would you treat a patient with constrictive pericarditis ?

 • Surgery is the only satisfactory treatment: Complete surgical resection of the pericardium (myocardial inflammation or fibrosis may delay symptomatic response).

Patients with tuberculous pericarditis should be pre-treated with antituberculosis therapy; if the diagnosis is confirmed after pericardial resection, full anti-tuberculous therapy should be continued for 6-12 months after resection. C.S. Beck (1894-1971), surgeon, Peter Bent Brigham Hospital in Boston. W. Broadbent(1868-1951), English physician who qualified from St Mary's Hospital Medical School, London. He described the Broadbent sign in constrictive pericarditis, which is an indrawing of the 11th and 12th left ribs with a narrowing and retraction of the intercostal space posteriorly; this occurs as a result of pericardial adhesions to the diaphragm.
How would you treat a patient with constrictive pericarditis ?

 • Surgery is the only satisfactory treatment: Complete surgical resection of the pericardium (myocardial inflammation or fibrosis may delay symptomatic response).

Patients with tuberculous pericarditis should be pre-treated with antituberculosis therapy; if the diagnosis is confirmed after pericardial resection, full anti-tuberculous therapy should be continued for 6-12 months after resection. C.S. Beck (1894-1971), surgeon, Peter Bent Brigham Hospital in Boston. W. Broadbent(1868-1951), English physician who qualified from St Mary's Hospital Medical School, London. He described the Broadbent sign in constrictive pericarditis, which is an indrawing of the 11th and 12th left ribs with a narrowing and retraction of the intercostal space posteriorly; this occurs as a result of pericardial adhesions to the diaphragm.

How would you investigate a patient with constrictive pericarditis ?

How would you investigate a patient with constrictive pericarditis ? 

• Chest radiograph typically shows normal heart size and pericardial calcification (note: the combination of pulsus paradoxus, pericardial knock and pericardial calcification favours the diagnosis of constrictive pericarditis).

• ECG shows low voltage complexes, non-specific T wave flattening or atrial fibrillation.

• Echocardiogram shows myocardial thickness is normal and may reveal thickened pericardium; normal ventricular dimensions with enlarged atria and good systolic and poor diastolic dysfunction.
 Doppler shows increased right ventricular systolic and decreased left ventricular systolic velocity with inspiration, expiratory aug-mentation of hepatic vein diastolic flow reversal.

• CT scan or MRI: shows normal myocardial thickness usually, and pericardial thickening and calcification.

• Cardiac catheterization typically shows identical left and right ventricular filling pressures and pulmonary artery systolic pressure usually
How would you investigate a patient with constrictive pericarditis ? 

• Chest radiograph typically shows normal heart size and pericardial calcification (note: the combination of pulsus paradoxus, pericardial knock and pericardial calcification favours the diagnosis of constrictive pericarditis).

• ECG shows low voltage complexes, non-specific T wave flattening or atrial fibrillation.

• Echocardiogram shows myocardial thickness is normal and may reveal thickened pericardium; normal ventricular dimensions with enlarged atria and good systolic and poor diastolic dysfunction.
 Doppler shows increased right ventricular systolic and decreased left ventricular systolic velocity with inspiration, expiratory aug-mentation of hepatic vein diastolic flow reversal.

• CT scan or MRI: shows normal myocardial thickness usually, and pericardial thickening and calcification.

• Cardiac catheterization typically shows identical left and right ventricular filling pressures and pulmonary artery systolic pressure usually

Mention some causes of constrictive pericarditis.

Mention some causes of constrictive pericarditis.

• Tuberculosis (<15% of patients).
• Connective tissue disorder.
• Neoplastic infiltration.
• Radiation therapy (often years earlier).
• Postpurulent pericariditis.
• Haemopericardium after surgery (rare).
• Chronic renal failure.
Mention some causes of constrictive pericarditis.

• Tuberculosis (<15% of patients).
• Connective tissue disorder.
• Neoplastic infiltration.
• Radiation therapy (often years earlier).
• Postpurulent pericariditis.
• Haemopericardium after surgery (rare).
• Chronic renal failure.

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