Pericarditis Flashcards
What is acute pericarditis?
Inflammation of the pericardium
What are the main causes of acute pericarditis?
- viral infections (Coxsackie)
- post-myocardial infarction
-early (1-3 days): fibrinous pericarditis
-late (weeks to months): autoimmune pericarditis (Dressler’s syndrome)
What is the main viral cause of acute pericarditis?
Coxsackie B virus
What is Dressler’s syndrome?
What is the characteristic feature of acute pericarditis?
Pleuritic chest pain
–Worse on inspiration and lying down
–Better on leaning forward
What improves pericardial chest pain?
Leaning forward
What exacerbates pericardial chest pain?
Inspiration
Lying down
What are the other possible presentations of acute pericarditis?
Non-productive cough
Dyspnoea
Flu-like symptoms
Pericardial rub
Tachypnoea and Tachycardia
How is acute pericarditis diagnosed?
ECG
What changes would you see on an ECG of someone with acute pericarditis?
Saddle shaped ST elevation
PR depression (main)
What is the medical management of acute pericarditis?
NSAIDs and colchicine
What is the main aim in the management of acute pericarditis?
Treat the underlying cause
What is constrictive pericarditis associated with?
Tuberculosis
Which malignancies are associated with acute pericarditis?
Lung cancer
Breast cancer
Hodgkin lymphoma
What is the main ECG change that would indicate acute pericarditis?
PR depression
Which connective tissue diseases are associated with acute pericarditis?
systemic lupus erythematosus
rheumatoid arthritis
What might you hear on auscultation if someone is presenting with acute pericarditis?
Percardial rub
What investigation must all patients have if acute pericarditis is suspected?
A transthoracic echocardiography
What would you check for in the blood of patients with suspected acute pericarditis?
Inflammatory markers
troponin (30%)
How are the majority of patients with acute pericarditis managed?
They are managed as outpatients- unless they have a fever >38
What should patients avoid until their inflammatory markers go down and symptoms resolve?
Strenuous physical activity
What are the other possible causes of pericarditis?
Hypothyroidism
Uraemia
Trauma
What might you find in the blood of someone with acute pericarditis?
Raised inflammatory makers (CRP, ESR, WCC)
Raised cardiac enzymes (e.g. troponin) if there is myocardial involvement
What might you see on a CXR in someone with pericarditis?
Cardiomegaly
What imaging would you use in everyone suspected of pericarditis?
Transthoracic echocardiography (TOE)
