Pericarditis

Question 1

Define pericarditis

Answer 1

Inflammation of the pericardium

May be acute, subacute or chronic

Question 2

Aetiology of pericarditis

9

Answer 2

Idiopathic
Infective
Connective tissue disease (e.g. sarcoidosis, SLE, scleroderma)
Post MI (occurs within 24-72 hrs in 20% patients)
Dressler’s syndrome (weeks/months after MI)
Malignancy - lung, breast, lymphoma, leukaemia, melanoma
Radiotherapy
Thoracic surgery
Drugs (e.g. hydralazine, isoniazid)

Question 3

Most common causative organisms of infective pericarditis

7

Answer 3

coxsackie B
echovirus 
mumps
streptococci
fungi
staphylococci
TB

Question 4

Epidemiology of pericarditis

prevalence x2, gender

Answer 4

UNCOMMON
<1/100 hospital admission
More common in males

Question 5

Presenting symptoms of pericarditis

1.4+2

Answer 5

CHEST PAIN
- sharp & central
- may radiate to neck or shoulders
- worse when coughing & deep inspiration (pleuritic pain)
- relieved by sitting forward 
Dyspnoea 
Nausea

Question 6

Signs of pericarditis on physical examination

3 + 1+ 1

Answer 6

Fever
Pericardial friction rub
Heart sounds may be faint due to pericardial effusion

Cardiac tamponade signs
Constrictive pericarditis signs

Question 7

Signs of pericarditis on physical examination - cardiac tamponade
(5)

Answer 7

Beck’s triad
raised JVP
low BP
muffled heart sounds
Tachycardia
Pulsus paradoxus

Question 8

Signs of pericarditis on physical examination - constrictive pericarditis
(7)

Answer 8

Kussmaul’s signs
Pulsus paradoxus 
Hepatomegaly
Ascites
Oedema
Pericardial knock (due to rapid ventricular filling)
AF

Question 9

Investigations for pericarditis

4 types

Answer 9

ECG
Echocardiogram
Bloods
CXR

Question 10

Investigations for pericarditis - ECG

Answer 10

Widespread saddle-shaped ST elevation

Question 11

Investigations for pericarditis

- echocardiogram

Answer 11

Assesses pericardial effusion & cardiac function

Question 12

Investigations for pericarditis
- bloods
(5)

Answer 12

FBC
U&Es
ESR/CRP
Cardiac enzymes (usually normal)
Others for cause: blood cultures, ASO titres, ANA, rheumatoid factor

Question 13

Investigations for pericarditis
- CXR
(2)

Answer 13

Usually normal

May be globular if there’s pericardial effusion

Question 14

Management of pericarditis - acute

Answer 14

Cardiac tamponade is treated w/ emergency pericardiocentesis

Question 15

Management of pericarditis - medical

2

Answer 15

Treat underlying cause

NSAIDs for pain & fever relief

Question 16

Management of pericarditis - recurrent

3

Answer 16

Low dose steroids
Immunosuppressants
Colchicine

Question 17

Management of pericarditis - surgical

Answer 17

Pericardiectomy is performed in cases of constrictive pericarditis

Question 18

Complications of pericarditis

3

Answer 18

Pericardial effusion
Cardiac tamponade
Cardiac arrhythmias

Question 19

Prognosis of pericarditis

3

Answer 19

Depends on underlying cause
Viral cases have GOOD prognosis
Malignant pericarditis has a POOR prognosis

Question 20

Hearing pericardial friction rub

Answer 20

heard best at lower left sternal edge, with patient leaning forward during expiration

Question 21

Define pulsus paridoxus

Answer 21

abnormally large decrease in SBP (> 10 mm Hg drop) & pulse wave amplitude during inspiration