The pericardium is a double-layered sac surrounding the heart, containing a small amount of fluid (<50 mL) to reduce friction.
Functions of Pericardium:
- Prevents Sudden Heart Expansion (During Exercise/Hypervolemia).
- Reduces Friction Between Heart & Surrounding Structures.
- Prevents Infections from Lungs Spreading to Heart.
Mnemonic: "P.R.I." (Prevents Expansion, Reduces Friction, Infection Barrier)
MAJOR DISEASES OF PERICARDIUM
1. Pericarditis
(Inflammation of Pericardium).
2. Pericardial
Effusion (Excess Fluid Accumulation).
3. Cardiac
Tamponade (Compression of Heart Due to Fluid Pressure).
Mnemonic: "P.E.C." (Pericarditis, Effusion, Cardiac Tamponade)
1.
PERICARDITIS (INFLAMMATION OF PERICARDIUM)
Types of Pericarditis:
• Acute Pericarditis → Dry or With Effusion.
• Chronic Pericarditis → Constrictive or Effusive.
Causes of Pericarditis:
• Viral (Coxsackie B, HIV, Influenza – Most Common).
• Bacterial (TB, Rheumatic Fever, Staph, Strep).
• Autoimmune (SLE, Rheumatoid Arthritis).
• Post-MI (Dressler’s Syndrome).
• Metabolic (Uremia, Myxedema – Hypothyroidism).
• Trauma, Surgery, Radiation, Drugs (Hydralazine, Procainamide).
Mnemonic: "V.B.A.P.M.T." (Viral, Bacterial, Autoimmune, Post-MI, Metabolic, Trauma)
SYMPTOMS OF PERICARDITIS
• Sharp, Stabbing Chest Pain (Worse on Lying Down, Relieved on
Sitting Up & Leaning Forward).
• Pain Radiates to Left Shoulder, Scapula, Epigastrium.
• Fever, Bodyache, Joint Pains.
• Breathlessness (If Effusion Develops).
Mnemonic: "S.P.F.B." (Sharp Pain, Pericardial Friction Rub, Fever, Breathlessness)
SIGNS OF PERICARDITIS
Pericardial Friction Rub → Superficial, Scratching
Sound Heard on Auscultation (Best Heard When Patient Leans Forward).
Tachycardia, Low BP (If Severe).
Mnemonic: "F.T." (Friction Rub, Tachycardia)
DIAGNOSIS OF PERICARDITIS
ECG:
• ST Elevation in All Leads (Concave Upwards – "Smiling
Face").
• No Reciprocal ST Depression (Unlike MI).
Chest X-ray:
• Normal in Dry Pericarditis, Enlarged Heart in Effusion.
Echocardiography (Best Test!):
• Detects Fluid in Pericardial Effusion.
Blood Tests:
• High ESR, CRP, WBC Count (Inflammation Markers).
Mnemonic: "E.C.E.B." (ECG, Chest X-ray, Echo, Blood Tests)
TREATMENT OF PERICARDITIS
- Bed Rest & Symptomatic Treatment.
- NSAIDs (Aspirin, Ibuprofen – Reduce Inflammation).
- Colchicine (Prevents Recurrence).
- Steroids (Only for Autoimmune Causes).
- Antibiotics (If Bacterial).
Mnemonic: "N.C.S.A." (NSAIDs, Colchicine, Steroids, Antibiotics)
2.
PERICARDIAL EFFUSION (FLUID IN PERICARDIUM)
Definition:
Excess fluid accumulation (>150 mL) in pericardial sac.
Causes of Effusion:
• Tuberculosis (Most Common in India).
• Cancer (Lung, Breast, Lymphoma).
• Uremia (Kidney Failure).
• Hypothyroidism (Myxedema).
• Viral, Autoimmune (SLE, Rheumatoid Arthritis).
Mnemonic: "T.C.U.H.V." (TB, Cancer, Uremia, Hypothyroidism, Viral)
SYMPTOMS OF PERICARDIAL EFFUSION
• Breathlessness (Due to Lung Compression).
• Dry Cough, Hoarseness (Recurrent Laryngeal Nerve Compression).
• Difficulty Swallowing (Esophagus Compression).
Mnemonic: "B.C.D." (Breathless, Cough, Difficulty Swallowing)
SIGNS OF PERICARDIAL EFFUSION
- Dull Heart Sounds (Muffled Heart Sounds).
- Neck Vein Fullness (Kussmaul’s Sign – JVP Rises in Inspiration).
- Pulsus Paradoxus (Drop in BP >10 mmHg on Inspiration).
Mnemonic: "D.N.P." (Dull Sounds, Neck Veins, Pulsus Paradoxus)
DIAGNOSIS OF PERICARDIAL EFFUSION
ECG:
• Low Voltage QRS, Electrical Alternans (Alternating QRS Size).
Chest X-ray:
• Water Bottle-Shaped Heart (Large Effusion).
Echocardiography (Best Test!):
• Detects Fluid in Pericardial Sac.
Mnemonic: "E.C.E." (ECG, Chest X-ray, Echo – Best Test)
TREATMENT OF PERICARDIAL EFFUSION
- Treat the Cause (TB, Cancer, Uremia).
- Diuretics (For Small Effusions).
- Pericardiocentesis (Drain Large Effusions, Prevent Tamponade).
Mnemonic: "T.D.P." (Treat Cause, Diuretics, Pericardiocentesis)
3.
CARDIAC TAMPONADE (LIFE-THREATENING EMERGENCY!)
Definition:
Severe pericardial effusion compressing the heart, preventing
proper filling & leading to shock.
Symptoms of Tamponade:
• Severe Breathlessness.
• Dizziness, Cold Sweats, Collapse.
Mnemonic: "B.D.C." (Breathless, Dizziness, Collapse)
Signs of Tamponade (BECK'S TRIAD):
• Low BP (Hypotension).
• High JVP (Neck Vein Distension).
• Muffled Heart Sounds.
Mnemonic: "B.H.M." (Beck’s = Hypotension, Muffled Sounds, High JVP)
Treatment:
• Emergency Pericardiocentesis (Needle Drainage of Fluid).
FINAL
REVISION WITH MNEMONICS
- Pericardial Diseases = "P.E.C." (Pericarditis, Effusion, Cardiac Tamponade)
- Pericarditis Causes = "V.B.A.P.M.T." (Viral, Bacterial, Autoimmune, Post-MI, Metabolic, Trauma)
- Symptoms = "S.P.F.B." (Sharp Pain, Pericardial Rub, Fever, Breathlessness)
- Diagnosis = "E.C.E.B." (ECG, Chest X-ray, Echo, Blood Tests)
- Treatment = "N.C.S.A." (NSAIDs, Colchicine, Steroids, Antibiotics)
- Effusion Diagnosis = "E.C.E." (ECG, Chest X-ray, Echo)
- Tamponade Signs = "B.H.M." (Beck’s = Hypotension, Muffled Sounds, High JVP)
