Sandbox/22: Difference between revisions

Jump to navigation Jump to search
Ayokunle Olubaniyi (talk | contribs)
Ayokunle Olubaniyi (talk | contribs)
Line 1: Line 1:
==Management==
==Management==
Shown below is an algorithm showing acute pericarditis management.<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:'''<br>
❑ Prodrome:<br>
♦[[Fever]] <br>  ♦[[Malaise]] <br>  ♦[[Myalgia]]<br>
❑ Retrosternal or left precordial [[chest pain]]:<br>
♦Radiates to trapezius ridge<br>  ♦Can be pleuritic <br>  ♦Can simulate ischemia <br>  ♦Varies with posture <br>
</div> }}
{{familytree | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | C01 | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Auscultation:'''<br>
❑ [[Pericardial rub]]<br>
♦Monophasic<br>  ♦Biphasic<br>  ♦Triphasic <br>
</div>}}
{{familytree | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | D01 | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">'''Perform ECG:'''<br>
❑ Convexly elevated J-ST segment<br>
❑ Determine ECK staging:<br> ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity <br> ♦ Early stage II: ST junctions return to the baseline, PR deviated <br> ♦ Late stage II: T waves progressively flatten and invert <br> ♦ Stage III: generalised T wave inversions <br> ♦ Stage IV: ECG returns to prepericarditis state
</div>}}
{{familytree | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | E01 | | | | | | | | |E01= <div style="float: left; text-align: left; line-height: 150% ">'''Echocardiography:'''<br> ❑ Effusion types B- D according to Horowitz classification: <br> ♦ Type A: No effusion <br> ♦ Type B: Separation of epicardium and pericardium (3–16 ml)<br> ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml)<br> ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion<br> ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space<br> ♦ Type E: Pericardial thickening (>4 mm)</div>}}
{{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}
{{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=<div style="float: left; text-align: left; line-height: 150% ">'''Order lab tests:''' <br> ❑  Inflammation markers: <br>♦[[ESR]] <br> ♦[[CRP]] <br> ♦[[LDH]] <br> ❑ Markers of myocardial lesion:<br> ♦[[Troponin I]] <br> ♦[[CK MB]]</div> }}
{{familytree | |,|-|^|-|.| | | | | |!| | | | }}
{{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]: <br>❑ “water bottle” heart shadow}}
{{familytree/end}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 21:13, 26 January 2014

Management

Shown below is an algorithm showing acute pericarditis management.[1]

 
 
 
 
 
 
Characterize the symptoms:

❑ Prodrome:
Fever
Malaise
Myalgia
❑ Retrosternal or left precordial chest pain:
♦Radiates to trapezius ridge
♦Can be pleuritic
♦Can simulate ischemia
♦Varies with posture

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Auscultation:

Pericardial rub
♦Monophasic
♦Biphasic
♦Triphasic

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Perform ECG:

❑ Convexly elevated J-ST segment
❑ Determine ECK staging:
♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity
♦ Early stage II: ST junctions return to the baseline, PR deviated
♦ Late stage II: T waves progressively flatten and invert
♦ Stage III: generalised T wave inversions
♦ Stage IV: ECG returns to prepericarditis state

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Echocardiography:
❑ Effusion types B- D according to Horowitz classification:
♦ Type A: No effusion
♦ Type B: Separation of epicardium and pericardium (3–16 ml)
♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml)
♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion
♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space
♦ Type E: Pericardial thickening (>4 mm)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evidence of pericardial effusion
 
 
 
 
 
Order lab tests:
❑ Inflammation markers:
ESR
CRP
LDH
❑ Markers of myocardial lesion:
Troponin I
CK MB
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Large recurrent effusion
 
Signs of cardiac tamponade
 
 
 
Perform chest X-Ray:
❑ “water bottle” heart shadow
 
 

References

  1. Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.