Medicine an Surgery notes

Apr 25th, 2015
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CONSTRICTIVE PERICARDITISIntroductionConstrictive pericarditis is a rare conditionin which the easily distensible, thin,parietal and visceral linings becomeinflamed, thickened and fused.Remains a diagnostic challenge to thisday.PathophysiologyImpedance to diastolic fillingAtrial pressures and ventricular end-diastolicpressures become equivalently elevated.CHF developsCardiac output is impaired, first with exerciseand then gradually at restSystolic function rarely affectedEtiologyClinical featuresEarly stages - subtle physical findings.Advanced stages - ill with marked wasting,jaundice.Clinical featuresSymptoms similar to those associatedwith right sided CHFPrecordial painDyspnoeaEasy fatiguabilityFeverTachycardiaAbdominal fullnessPalpitationsOrthopnoeaParoxysmal nocturnal dyspnoeaHacking non-productive coughClinical featuresCardiovascular systemImpalpable apical impulseDistant heart soundsSinus tachycardiaFriction rub most frequent finding.Protodiastolic knock corresponds to abrupt cessationof ventricular filling, is pathognomonic of pericardialconstrictionClinical featuresFeatures consistent with right sidedHeart failure Neck vein distension Hepatojugular reflux Hepatomegaly Ascitis Peripheral oedema Pulsus paradoxus (rare) Prominent third heart sound Diminished pulse volu

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