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The CHASER pathway for the management of Pericardial Diseases

The CHASER pathway for the management of Pericardial Diseases . Acute Subacute chronic. R ight Predominant Heart Failure . H ypotension , syncope, PEA A rrest . S hortness of breath. C H est pain. E cho or imaging of pericardial effusion . 1. Clinical.

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The CHASER pathway for the management of Pericardial Diseases

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  1. The CHASER pathway for the management of Pericardial Diseases AcuteSubacute chronic Right Predominant Heart Failure Hypotension, syncope, PEAArrest Shortness of breath CHest pain Echo or imaging of pericardial effusion 1 Clinical High Risk Etiologies for Constrictive Pericarditis (T4) Type : Sharp Pleuritic Positional High risk conditions for tamponade (T2) Assess for Etiology (T3) 2 Physical Tachycardia Pulsusparadoxus JVD Clear lungs Kussmaul sign Pericardial “knock” Right heart failure findings Clear lungs Friction Rub Stable vital signs Low Voltage QRS Electrical Alternans 3 ST elevation PR depression (T1) EKG Low voltage QRS Non-specific STT changes Atrial fibrillation 4 Echocardiographic findings suggestive of constrictive pericarditis (T5) Any significant effusion Echo Hemodynamic compromise criteria ≥2/4 • Etiologies Consider - TEE - CT/MRI - Cardiac Catheterization • Echo Hemodynamic Findings • Aortic Dissection 4 ptsPurulent effusion 4 pts • Trauma 4 pts ≥2/4 criteria Tamponade Acute Pericarditis Diagnostic workup TIER 1 TESTS CBC, BMP, LFTs, Coagulation profile CXR Inflammatory markers Cardiac enzymes TST/Quantiferone Echocardiography TIER 1 TESTS CBC, Basic metabolic panel, liver function tests, PT,PTT, ESR, CRP, Cardiac biomarkers, TSH, PPD/Quantiferone, CXR Constrictive Pericarditis Recent onset, acute inflammatory component Yes No Idiopathic/Viral Inflammatory Pericarditis Rx: Ibuprofen 800 mg Q6-8h 7-10 days OR aspirin 800 mg Q6-8h 7-10 days PLUS Colchicine 1-2 mg first day followed by 0.5 mg daily or BID for 3 months AVOID corticosteroids Ibuprofen 800 mg Q6-8h 7-10 days OR aspirin 800 mg Q6-8h 7-10 days PLUS Colchicine 1-2 mg first day followed by 0.5 mg daily or BID for 3 months AVOID corticosteroids OR Treat specific etiology If found (e.g. TB) Found specific etiology? Medical management Persistent symptoms in one week (fever, pain, weight loss) or increasing effusion Yes Effusive-Constrictive Pericarditis Evidence of high pressures after drainage? Score ≥4 TIER 2 TESTS ANA/AutoAb HIV, TSH, Blood Cultures CT/MRI Invasive management consider Pericardial drainage Surgical Management Treat specific etiology

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