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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
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