2. • Cardiovusculer involvement is relatively
uncommon in patient with TB and has been
described 1-2% of patient
• It mainly affect the pericardium
• Although cardiovusculer involvement is
secondary to TB elsewhere in the body it may
be the only clinical menifestation of TB
4. Stage of TB Pericarditis
• Dry stage
• Effusion stage
• Absoptive stage
• Constrictive stage
Mortality rate of acute pericarditis is more
than 80% in acute stage and still more later
stage due to constrictive pericarditis
5. • Pericardial effusion is an abnormal
accumulation of fluid in the pericardial cavity.
• Normal levels of pericardial fluid are from 15
to 50 ml
6. Pathogenesis
• Pericardial involvement most commonly result
from direct extension from of infection from
adjacent mediastinal lymph node but
occasionally be haematogenous, e.g. in milliary
TB
• While acute pericarditis appear to be
hypersensitivity reaction to tuberculoprotein
chronic pericarditis reflect granuloma formation
which then progress to fibrosis and then
calcification
7. Symptoms
• Low grade fever
• Malaise
• Night sweats
• Cough
• Weight loss
• Retrosternal discomfort
• Palpitation
• Breathlessness on exertion or even at rest
• Orthopnoea
9. Precordium examination:
• Fullness of intercostal space
• Apex beat is difficult to palpate
• Area of cardiac dullness increased on purcussion
• Heart sounds are muffled or distant
Abdomen examination:
• Liver is enlarged and tender
• Ascitis
Respiratory system examination:
• Bronchial breath sound at left inferior angle of scapula
(Ewart’s sign) due to compression of base of left lung
by enlarged heart
10. Investigation
1. Chest Xray AP view:
•Globular enlargement of the
cardiac shadow giving a water
bottle configuration
•Widening of the subcarinal
angle
•Oligaemic lung field
11. 2. Chest X ray lateral view
A vertical opaque
line separating a vertical
lucent line directly behind the
sternum (Oreo cookie sign)
12. 3. ECG
• Low voltage ECG
• Tachycardia
• Electrical alternans
• T inversion
15. 5. CXR trendelenberg position – base of the heart will
be wide
6. Sputum smear and culture
7. MT positive in 80 -100 % case
8. CT scan –used to demonstrate pericardial
thickening with fluid
16. 9. Pericardiocentesis:
• Done for both diagnosis and relief of
symptoms
• Straw coloured or sarosanguinous
• Exudative
• Lymphocytic predominant on cytology
• ADA >30 U/L
• AFB may be found on pericardial fluid
17. 10.Pericardial biopsy:
• Done by thoracotomy or percutaneously using a
bioptome
• Histology shows granulomatous lesion
• Shows positive result in upto 70% cases
• Nonspecific histological change doesn’t exclude
TB
• Pericardial tissue culture can be done for
Tuberculosis
18. Treatment
Medical management:
CAT-1 anti TB regiment:
• 4FDC (HRZE) -2 month
• 2FDC (HR)- 4 month
Corticosteroid therapy:
• Improve rapid resolution of pericardial fluid
• Reduce need for repeated pericardiocentasis
• Reduce need for surgery
• Reduce mortality
19. • Dose- Tab Prednisolone
• 60mg/day for 4 weeks
• 30mg/day for 4 weeks
• 15mg/day for 2 weeks
• 5mg/day for 1 week
20. Surgical management:
• Those with late presentation of constriction or
calcification
• Those who have life threatening tamponade at
any stage
• Who fail to respond to the initial 6-8 month of
medical treatment
• Have a raise venous pressure
Procedure:
– Pericardiectomy producing a pericardial window
for pericardial thickening
23. Role of Cadiologists:
• Diagnosis by Echocardiography
• Pericardiocentesis
Role of Pulmonologists :
• Medical management of tuberculous pericardial
effusion
• Idendify the primary source
Role of Thorasic surgeons:
• Pericardiectomy for pericardial thickening
24. • Tuberculous pericardial effusion is always
secondary involvement of primary TB
• Early detection and management can prevent
grave complication like cardiac temponade
• Cardiologists, pulmonologists and thorasic
surgeon are needed for comprehensive
management of this patient
