acute pericarditis Flashcards
What is the prognosis for acute pericarditis?
Excellent, with less than 0.5% developing long-term sequelae.
What are potential complications of acute pericarditis?
Cardiac tamponade, pericardial effusion, and constrictive pericarditis (rare).
What is the first-line treatment for idiopathic or viral pericarditis?
Exercise restriction and NSAIDs (+ PPI) for 1-2 weeks.
When is colchicine used in acute pericarditis?
As second-line therapy for those who cannot tolerate or have refractory cases to NSAIDs.
What is the first-line treatment for bacterial pericarditis?
IV antibiotics +/- pericardiocentesis if purulent exudate is present.
How can you differentiate pericarditis from acute coronary syndrome?
Pericarditic pain is sharp, pleuritic, and positional; ACS pain is a squeezing pressure not affected by position.
Name one condition that can mimic pericarditis with positional chest pain.
Gastro-oesophageal reflux disease (GORD).
What are the key ECG findings in acute pericarditis?
Widespread ST elevation and PR depression.
What blood tests can help diagnose acute pericarditis?
Serial troponins (consistently elevated), inflammatory markers (CRP, ESR), and viral serology.
What imaging is used to distinguish between pericarditis and MI?
Echocardiogram.
Name three infectious causes of acute pericarditis.
- Viruses: Coxsackie B, echovirus, CMV, HIV.
- Bacteria: Staphylococcus, pneumococcus, M. tuberculosis.
- Fungi and parasites (rare).
Name two malignancies that can cause acute pericarditis
Name two malignancies that can cause acute pericarditis.
What autoimmune diseases can cause acute pericarditis?
Systemic lupus erythematosus (SLE), rheumatoid arthritis, and sarcoidosis.
What is a characteristic sign of acute pericarditis?
Pericardial friction rub, a high-pitched scratching noise heard over the left sternal border during expiration.
What triad is associated with cardiac tamponade as a complication?
Beck’s Triad: hypotension, raised JVP, muffled heart sounds.
What are the key symptoms of acute pericarditis?
Pleuritic chest pain (worse on inspiration).
Postural chest pain (worse lying flat, relieved by leaning forward).
Fever.
What is acute pericarditis?
Inflammation of the pericardium, the sac surrounding the heart, often following a viral infection.
What is the recommended duration of colchicine therapy for acute pericarditis?
Colchicine is recommended for 3 months to reduce recurrence rates.
When should corticosteroids be considered in the management of acute pericarditis?
Corticosteroids should be considered in cases of contraindications or failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease.
What are the major risk factors associated with poor prognosis in acute pericarditis?
Fever >38°C
Subacute course
Large pericardial effusion
Cardiac tamponade
Lack of response to NSAIDs after 7 days
What are the empirical first-line antibiotics for bacterial pericarditis caused by common bacteria?
Broad-spectrum antibiotics such as:
Vancomycin: Covers gram-positive organisms, including Staphylococcus aureus.
Ceftriaxone or cefotaxime: Covers gram-negative organisms.
What antibiotic regimen is recommended for bacterial pericarditis suspected to be caused by Mycobacterium tuberculosis?
A combination anti-TB regimen including:
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
For at least 6 months (with a longer duration if required for extrapulmonary TB).
When should pericardiocentesis be performed in bacterial pericarditis, and how does it influence antibiotic choice?
Pericardiocentesis should be performed when purulent effusion is present. The fluid should be sent for gram staining and culture to guide targeted antibiotic therapy.
What is the pericardial cavity, and what is its function?
A potential space between the two layers of the pericardium filled with less than 50 mL of fluid, providing lubrication and reducing friction during heartbeats.
How does pericardial effusion affect the heart?
It creates inward pressure, making it more difficult for the heart to expand during diastole, reducing cardiac output.
What is cardiac tamponade, and how does it affect heart function?
A large pericardial effusion increases intra-pericardial pressure, compressing the heart and reducing diastolic filling and systolic output.
Name a medication that can cause pericarditis.
Methotrexate.
What are the two layers of the pericardium separated by?
A potential space filled with less than 50 mL of lubricating fluid.
buzzwords
Pleuritic chest pain: sharp, worse on inspiration.
Positional chest pain: worse lying flat, relieved by sitting forward.
Pericardial friction rub: high-pitched scratching sound on auscultation.
Saddle-shaped ST elevation: characteristic ECG finding.
PR depression: diagnostic ECG feature.
Colchicine: used for prevention of recurrence.
NSAIDs: first-line treatment.
Pericardial effusion: fluid in pericardial cavity.
Cardiac tamponade: emergency with Beck’s triad (hypotension, raised JVP, muffled heart sounds).
Raised inflammatory markers: CRP, ESR, WBC.
Echocardiogram: diagnostic for effusion.
