“ Inflammation of the pericardium” Chest pain Dry cough, fever, fatigue Pericardial rub ST elevation on ECG Cardiac tamponade CCF.

“ Inflammation of the pericardium”

Chest pain Dry cough, fever , fatigue Pericardial rub ST elevation on ECG Cardiac tamponade CCF

• Infection -viral, bacterial• Secondary to recent cardiac surgery• Post MI• IV Drug abuse• Kidney failure• Metatastic disease

Restricts the heart – reduces operative chamber compliance

Thickened pericardium isolates heart from normal respiratory swing, however respiratory fluctuations in pulmonary venous pressure still occurs

Tamponade

Bacterial – antibiotics Fungal – antifungal agents Hospitalisation Constictive

Pericardetomy may be required

ST elevation in any lead May be in all leads May not be anatomically grouped J-point notching can be

presentpresent Fish hook

• Look for notch at J-pointLook for notch at J-point

– ST segment and J-point create a “fish ST segment and J-point create a “fish hook” appearancehook” appearance

Stage Ieverything is UP (i.e., ST elevation in almost all leads - see below)

Stage IITransition ( i.e., "pseudonormalization").

Stage IIIEverything is DOWN (inverted T waves).

Stage IV Normalization

Inflammation of the heart muscle

Generalised aches and pains fever SOB chest pain Increase in heart rate

Viral – coxsackievirus B Bacteria – Staphyloccus aureus, borrelia

burgdorferi Diptheria Parasites – trypanosoma cruzi Fungi Chemicals Medications Systemic diseases

ECG – non specific changes Echo- enlarged heart Biopsy

NB ECG can be normal

REST Steroids – severe cases May need to manage electrolyte

imbalances or complications of heart failure

NB 10% of patients proceed to develop dilated cardiomyopathy