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Iran Specialty Board - Cardiology study materials
Iran Specialty Board - Cardiology study resources

Iran Specialty Board - Cardiology: Pericardial and Myocardial Disease

Iran Specialty Board - Cardiology · Work through your exam, one topic at a time.

All guide sections

Pericardial and Myocardial Disease

Items test the distinction between pericarditis and infarction, the bedside recognition of tamponade, the haemodynamics of constriction, and the modern work-up of myocarditis with cardiac magnetic resonance.

Acute pericarditis

  • Diagnostic triad: pleuritic chest pain relieved by sitting forward, pericardial friction rub, and diffuse ST elevation with PR depression.
  • Treat with NSAID plus colchicine; restrict exercise; reserve corticosteroids for contraindications to NSAIDs because they increase recurrence.
  • High-risk features requiring admission: fever above 38 degrees, subacute course, large effusion, tamponade, or immunosuppression.

Tamponade and constriction

  • Tamponade: hypotension, distended neck veins, muffled heart sounds, pulsus paradoxus above 10 mmHg, electrical alternans, and diastolic collapse of right-sided chambers on echo; treat with pericardiocentesis.
  • Constrictive pericarditis: Kussmaul sign, pericardial knock, septal bounce, annulus reversus with medial e-prime exceeding lateral, and equalisation of diastolic pressures; treat with pericardiectomy.

Myocarditis

  • Viral prodrome with chest pain, troponin rise, and arrhythmia; ST changes without regional distribution.
  • Cardiac MRI uses Lake Louise criteria: myocardial oedema on T2 mapping plus non-ischaemic late gadolinium enhancement.
  • Treat heart failure and arrhythmia; avoid strenuous exercise for 3-6 months; giant cell myocarditis needs immunosuppression and early transplant assessment.

Worked example

A 28-year-old with fever and sharp chest pain has diffuse ST elevation, PR depression, troponin mildly elevated, and a small effusion. This is myopericarditis, not STEMI: give ibuprofen plus colchicine, avoid anticoagulation, and do not take him to the catheter laboratory.

Traps

  • Anticoagulating presumed pericarditis can cause haemorrhagic effusion.
  • Post-infarction pericarditis and Dressler syndrome occur at different times after the event.
  • A normal ECG does not exclude tamponade; look for pulsus paradoxus and echo signs.