Pericarditis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
The classic sign of pericarditis is a friction rub. A careful examination must be performed to exclude the presence of cardiac tamponade, a dangerous complication of pericarditis. If cardiac tamponade is present, then pulsus paradoxus, hypotension), an elevated jugular venous pressure and peripheral edema may be present.
Appearance of the Patient
- Fever less than 39° C or 102.2° F
- Patients who are elderly may not exhibit fever; however, they may be hypothermic especially those with renal failure.
- Chills (suppurative pericarditis and idiopathic (viral) pericarditis)
- Weakness
- Anxiety
- Pallor (may also indicate tuberculosis, uremia, neoplasia, and rheumatic carditis)
Heart
- Pericardial friction rub: This is the classic physical examination finding in pericarditis. It is usually heard with acute pericarditis, and occasionally with either subacute or chronic pericarditis. There are several differnnt pericardial rubs that can be auscultated:
- Endopericardial rub: this occurs as the result of inflamed, scarred or tumor-invaded serosal surfaces
- Exopericardial rub: this occurs after sclerotherapy of effusions, and is due to friction between the parietal pericardium and the pleura (or chest wall occasionally)
- Endo-exopericardial rub: occurs with both of the above
- Pleuropericardial rub: occurs as a result of both pleural and pericardial inflammation
Signs that a Significant Pericardial Effusion and/or Cardiac Tamponade May be Present
Initial diagnosis can be challenging, as there are a number of differential diagnoses, including Tension pneumothorax [1], and acute heart failure.
Classical cardiac tamponade presents three signs, known as Beck's triad. Hypotension occurs because of decreased stroke volume, jugular venous distension due to impaired venous return to the heart, and muffled heart sounds due to fluid inside the pericardium [2] Another sign of tamponade on physical examination includes pulsus paradoxus (a drop of at least 10 mmHg in arterial blood pressure on inspiration) [3]. There may also be general signs & symptoms of cardiogenic shock (such as tachycardia, breathlessness, poor perfusion of the extremities and decreasing level of consciousness). Peripheral edema may be present. Hemodynamic changes diminish S1 and S2 . As Ventricular volume shrinks disproportionately, there may be psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures that result in clicks.
Signs that Pericardial Constriction is Present
- Peripheral edema may be present in the setting of pericardial constriction
References
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
- ↑ Dolan, B., Holt, L. (2000). Accident & Emergency: Theory into practice. London: Bailliere Tindall ISBN 978-0702022395
- ↑ Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams & Wilkins ISBN 978-0781749886
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