Page 78 - Clinical Pearls in Cardiology

66 Clinical Pearls in Cardiology

idiopathic pericarditis (usually viral) and immediate
postoperative period following cardiac surgery.
8. What is Dressler’s syndrome?
Dressler’s syndrome is a form of autoimmune pericarditis
that may occur weeks to several months after a myocardial
infarction or open heart surgery. Large pericardial
effusions do occur, but cardiac tamponade is very rare in
patients with Dressler’s syndrome. NSAIDs (e.g. aspirin)
and corticosteroids are effective in treatment.
9. What are the commonest causes of constrictive
pericarditis?
The commonest cause of constrictive pericarditis in
developing countries like India is tuberculosis. Some of
the other common causes include the following:
• Idiopathic or post-viral
• Purulent pericarditis (usually S. aureus)
• After cardiac surgery
• After chest irradiation
• Trauma
• Neoplastic infiltration.
10. How will you clinically differentiate between
constrictive pericarditis and cardiac tamponade?
Both constrictive pericarditis and cardiac tamponade
are associated with a raised JVP. Examination of certain
characteristics of the jugular venous pulse is very useful
in differentiating between these two conditions (Table 3).
Table 3: Differentiation between constrictive pericarditis
and cardiac tamponade
Constrictive pericarditis Cardiac tamponade
Systolic retraction of apical No systolic apical retraction
impulse present
(Broadbent’s sign)
Contd...