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Chapter 2: Disorders of pericardium, myocardium and endocardium 65
Sex Atrial fibrillation is a common complication and
M > F should be treated appropriately.
Geography Prognosis
Related to the extent of cigarette smoking. This is related to the underlying lung pathology and ex-
tent of respiratory failure.
Aetiology
The most common cause is chronic obstructive pul-
monary disease.
Chronic lung disease: Chronic bronchitis, emphy- myocardium and endocardium
Disorders of pericardium,
sema,asthma,pulmonaryfibrosis,bronchiectasis,cys-
tic fibrosis.
Pulmonary hypertension. Disorders of the pericardium
Recurrent pulmonary emboli.
Obstructive sleep apnoea. Acute pericarditis
Definition
Pathophysiology
Acute pericarditis is an acute inflammation of the peri-
Hypoxia is a potent cause of pulmonary arterial vaso-
cardial sac.
constriction, this coupled with an effective loss of lung
tissueresultsinprogressivepulmonaryhypertensionand
henceincreasedpressureloadontherightventricle.With Aetiology
time there is compromise of right ventricular function Multiple aetiologies but common causes are as follows:
and development of right ventricular failure, often with Myocardial infarction: 20% of patients develop acute
tricuspid regurgitation. pericarditis in the first few days following an infarc-
tion, although it is often asymptomatic and therefore
Clinical features goes undetected. Dressler’s syndrome is an immune-
Pulmonary hypertension, right ventricular failure and mediated pericarditis occurring between 1 month and
the chest disease together produce the clinical picture. 1year in <1% of patients following myocardial infarc-
Dyspnoea, cyanosis, elevated jugular venous pressure, tion and is associated with a high ESR.
Viruses: The specific agent is often unidentified but
peripheral oedema and hepatic congestion may occur.
may include coxsackie B, influenza, measles, mumps,
Investigations varicella and HIV.
The ECG may be normal or may show tall peaked P Other causes include uraemia, connective tissue dis-
waves in lead II, right ventricular hypertrophy, right axis orders, trauma, rheumatic fever, tuberculosis and ma-
deviation or right bundle branch block. The use of chest lignant infiltration. Acute bacterial pericarditis is un-
X-ray, CT scan and lung function tests may help identify usual.
the underlying lung disease. Echocardiography is used
to exclude left-sided heart failure. Pathophysiology
During acute pericarditis the pericardium is inflamed
Management and covered in fibrin causing a loss of smoothness and
Heart failure should be treated and the underlying
an audible friction rub on auscultation.
lung pathology should be treated vigorously.
Acutechestinfectionsshouldbetreatedpromptlywith Clinical features
antibiotics and steroids where appropriate. Sharp substernal pain with radiation to the neck and
Long-termoxygentherapyhasbeenshowntoimprove shouldersandsometimestheback.Characteristicallythe
prognosis in hypoxic chronic obstructive airways dis- pain is relieved by sitting forward and made worse by ly-
ease but must be maintained for >18 hours per day. ing down, movement or deep inspiration. A pericardial