Acute pericarditis case

Question 1

What are the typical symptoms of pericarditis

Answer 1

Central pleuritic chest pain, orthopnea that is relieved by leaning forward
Normally no radiation

Question 2

What examinations would you order

What would you find

Answer 2

CV

-pericardial murmur that is accentuated by leaning forwards

Question 3

What investigations would you order

What would you find

Answer 3

Tnt
-normal/slightly elevated to rule out MI

ECG
-widespread saddle shaped ST elevation

CXR
-goblet shaped heart shadow

Question 4

What are the possible causes of pericarditis

Answer 4

Infectious (fever, rash?)

• viral, (Coxsackle A, B, varicella, herpes, flu)
• bacterial
• TB

Idiopathic

Inflammatory

• Dressler syndrome
• connective tissue disorder

Surgery/trauma

Pulmonary HTN

Neoplastic
-primary, metastatic, lymphoma

Metabolic

• hypothyroidism
• uremia

Question 5

What are the complications of pericardial effusion

Answer 5

Large effusions
-breathlessness => cardiac tamponade => cardiogenic shock => hypotension => cerebral underperfusion

NEEDS PERICARDIOCENTESIS