PERICARDIAL DISEASE

Acute Pericarditis causes: saddle shaped ST elevation on ECG, raised Troponin Coxsackie B is the commonest cause. Other causes are HIV, diphtheria, Chagas disease, Lyme disease, SLE and arsenic poisoning.

In constrictive pericarditis, because the atria are equilibrated with the ventricles in early diastole, the jugular venous waveform and right and left atrial waveforms show a prominent and deep y descent. The systolic x descent is usually also present.

The main feature in chronic constrictive pericarditis is restriction of diastolic filling of ventricles. This may lead to the pericardial knock during ventricular filling. Ascites can occur due to chronic venous congestion and liver cirrhosis. Poor ventricular

filling can lead to a low pulse pressure.

Summary signs of constrictive pericarditis are:

• rapid x and y descent

• ascites

• hepatomegaly

• ankle oedema

• pulsus paradoxus can occur but is less common especially in chronic constrictive pericarditis