RT Book, Section A1 Sorajja, Paul A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107717617 T1 Pericardial Disease T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107717617 RD 2024/11/11 AB The diagnosis of acute pericarditis should be made on the basis of typical chest pain symptoms, the presence of a pericardial friction rub, and electrocardiographic abnormalities, which are distinctive from changes due to myocardial ischemia.Although a comprehensive evaluation is usually warranted in patients with acute pericarditis, the diagnostic yield is low with causes identified in less than 20% of patients.High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and adjunctive colchicine are effective medical therapy for acute pericarditis, except in episodes due to acute coronary syndromes where NSAIDs are contraindicated.Pulsus paradoxus is a bedside finding of cardiac tamponade that arises from compromise in left ventricular stroke volume during inspiration and a subsequent fall in stroke volume.Echocardiography is the primary diagnostic modality for tamponade. Signs include diastolic inversion or collapse of the right atrium and right ventricle, ventricular septal shifting with respiration, enlargement of the inferior vena, and respiratory variation in transmitral flow.In patients in whom invasive monitoring is available (eg, Swan-Ganz catheter) cardiac tamponade manifests as blunting or absence of the y descent, elevation in filling pressures, tachycardia, and reduced cardiac output.The diagnosis of constrictive pericarditis can be made with echocardiography in most patients, with invasive catheterization reserved for patients in whom the clinical findings and noninvasive studies cannot definitively establish the diagnosis.