Sandbox/22: Difference between revisions
< Sandbox
| 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: | |||||||||||||||||||||||||||||||||
Auscultation: ❑ Pericardial rub | |||||||||||||||||||||||||||||||||
Perform ECG: ❑ Convexly elevated J-ST segment | |||||||||||||||||||||||||||||||||
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
- ↑ 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.