Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium

Question 2

Causes
1) Name a viral cause
2) Name a bacterial cause
3) Name an autoimmune cause
4) Name a drug that can cause pericarditis
5) Name another cause

Answer 2

1) EBV, CMV, coxsackievirus, adenovirus, mumps, varicella
2) TB, lyme disease, Q fever, rheumatic fever, pneumonia, staphylococcus, streptococcus, legionella
3) SLE, Dressler’s syndrome, amyloidosis, sarcoidosis, rheumatoid arthritis
4) Chemotherapy, procainamide, hydralazine
5) Uraemia, hypothyroidism, malignancy

Question 3

What is Dressler’s syndrome?

Answer 3

Immune response against damaged heart tissue that results in inflammation of the pericardium. The initial damaged heart tissue is usually caused by an MI

Question 4

Name a clinical feature

Answer 4

• Central chest pain worse on inspiration and lying flat (improved by leaning forward)
• Pericardial friction rub
• Signs of fever
• Raised troponins

Question 5

1) Name an ECG change that would be seen acutely in pericarditis
2) After 1-3 weeks what ECG change may be seen?

Answer 5

1) Saddle-shaped ST elevation and PR depression (latter = most specific)
2) T wave flattening

Question 6

1) What is constrictive pericarditis?
2) The features are mainly due to what pathology?
3) Name one of these features

Answer 6

1) Pericarditis caused by permanent thickening and rigidity of the pericardium
2) Right sided heart failure
3) Raised JVP, quiet heart sounds, diffuse apex beat, ascites, oedema, hepatosplenomegaly

Question 7

Name a complication of pericarditis

Answer 7

• Pleural effusion
• Cardiac tamponade

Question 8

1) What is the 1st line management of idiopathic/viral pericarditis?
2) What drug can be given as adjunctive treatment?
3) This drug is used in caution in what patients?
4) What is 2nd line medication?
5) Why is the 2nd line medication used in patients with non-viral pericarditis, and not the 1st line?

Answer 8

1) Exercise restriction and NSAIDs
2) Colchicine
3) Hepatic or renal impairment
4) Corticosteroids
5) Re-actviation risk with corticosteroids in viral pericarditis

Question 9

All patients with suspected acute pericarditis should have what investigations?

Answer 9

Transthoracic echocardiography, repeated ECGs and serial troponins

Question 10

Acute pericarditis may re-occur in up to what percentage of cases?

Answer 10

30%

Question 11

In a pericardiocentesis, where is the needle inserted?

Answer 11

Subcostally in the midline aiming for the left shoulder

Question 12

Is bacterial or viral pericarditis the commonest?

Answer 12

Viral

Question 13

If a patient with pericarditis has elevated troponins, this could be a sign of what?

Answer 13

Myopericarditis