Acute Pericarditis Flashcards
A 25-year-old patient presents with splinted breathing and sharp, precordial chest pain that radiates to the back. The pain increases with inspiration and is mildly relieved by placing the patient in a forward sitting position. What might the EKG show?
The patient probably has pericarditis. The EKG may reveal intermittent supraventricular tachycardias, ST-segment depression in leads aVR and VI with ST segment elevation in all of the remaining leads. PR depression and T-wave inversion may also arise.
What is the most common cause of pericarditis?
Idiopathic. Viral pericarditis is a common cause and the most common infectious etiology. Other causes are myocardial infarction, post–viral syndrome, aortic dissection that has ruptured into the pericardium, malignancy, radiation, chest trauma, connective tissue disease, uremia, and drugs, that is, procainamide or hydralazine.
What physical findings indicates acute pericarditis?
Pericardial friction rub. The rub is heard best at the left sternal border or apex with the patient in a forward sitting
position. Other findings include fever, tachycardia, and pleuritic chest pain.
What will be the appearance of a pericardial effusion on an X-ray?
A water bottle silhouette.
What is the treatment for pericarditis without effusion?
A 2-week treatment of 650-mg aspirin every 4 hours, if no contraindications exist. Ibuprofen, indomethacin, or colchicines are other alternatives. The use of corticosteroids is controversial because recurrent pericarditis is common as the dose is tapered.
What are some viral causes of pericarditis?
- Coxsackie virus A, coxsackie virus B
- Echovirus
- Mumps
- Adenovirus
- HIV
- Infectious mononucleosis
- Varicella
- Hep B
What is pericarditis?
Acute inflammation of the pericardium, with or without pericardial effusion
What are clinical presentations of pericarditis?
- Chest pain
- Positional: may be relived by sitting up and leaning forward, worse in supine
- Pleuritic (usually sharp and on inhalation)
- Radiates to left shoulder
- Dyspnea
What would you see on physical exam on a patient with pericarditis
- Fever
- Pericardial friction rub, more prominent when leaning forward
- Ewart’s sign: path of dullness on auscultation beneath the angle of the left scapula
What is the gold standard for diagnostic tools in pericarditis?
- Echocardiogram ** Always**: Can distinguish pericarditis from MI
- Will show pericardial effusion and will not have wall motion abnormalities
What drugs do you use to treat post MI pericarditis?
Aspirin – 650-1000mg 4x/day (qid) – 7-10 days then taper over 4 weeeks
What drugs are contraindicated in the treatment of post MI pericarditis?
NSAIDs and steroids – delay healing
What drugs do you use to treat non-MI pericarditis?
o 1st line: NSAIDs 2-4 wks (ibuprofen 600 mg 6 hrs 4 wks | indomethacin 25-50 mg tid 4 wks)
o 2nd line: Colchicine and Aspirin – give together
• Aspirin: 800 mg q6-8 h for 7-10 days then taper 3-4 wks
• Colchicine: 1-2 mg on day 1, .5 to 1 mg/day for 3 mo (1/day for 70)
What drugs do you avoid in the treatment of Acute Pericarditis?
heparin and warfarin
If pericarditits is left untreated, what is a complication?
Cardiac Tamponade
