Acute pericarditis

Question 1

Causes?

Answer 1

• viral infections (Coxsackie)
• tuberculosis
• uraemia (causes ‘fibrinous’ pericarditis)
• trauma
• post-myocardial infarction, Dressler’s syndrome
• connective tissue disease
• hypothyroidism
• malignancy

Question 2

Symptoms and signs?

Answer 2

• chest pain: may be pleuritic. Is often relieved by sitting forwards
• other symptoms include non-productive cough, dyspnoea and flu-like symptoms
• tachypnoea
• tachycardia

Question 3

What changes are seen in ECG?

Answer 3

• the changes in pericarditis are often global/widespread, as opposed to the ‘territories’ seen in ischaemic events
• ‘saddle-shaped’ ST elevation
• PR depression: most specific ECG marker for pericarditis

Question 4

What investigations should be performed?

Answer 4

ECG and transthoracic echocardiography

Question 5

Management?

Answer 5

• treat the underlying cause
• a combination of NSAIDs and colchicine is now generally used for first-line for patients with acute idiopathic or viral pericarditis

Question 6

What is pericardial rub?

Answer 6

It is a sound caused by friction between the inflamed pericardial surfaces. It is a rocking to-and-fro sound that resembles walking in fresh snow. It is more pronounced with the patient leaning forward.

Question 7

What sound may be heard in this condition?

Answer 7

Pericardial rub