Pericarditis Flashcards
What is pericarditis?
Inflammation of the pericardium
What are the causes of acute pericarditis?
Idiopathic
Viruses
Bacteria
Fungi and parasitic
Autoimmune
Drugs
Metabolic
Others trauma, surgery malignancy radiotherapy MI chronic HF
List viral causes of acute pericarditis
coxsackie
echovirus
EBV
CMV
adenovirus
mumps
varicella
HIV
List bacterial causes of acute pericarditis
TB (commonest worldwide)
Lyme disease
Q fever - caused by Coxiella burnetti
pneumonia
rheumatic fever
Staphs
Streps
mycoplasma
legionella
Mycobacterium avium-intracellulare (MAI) in HIV
List autoimmune causes of acute pericarditis
SLE
RA
vasculitides like Behcet, Takayasu
IBD
sarcoid
amyloid
Dressler’s syndrome
List the drugs that can cause acute pericarditis
procainamide
hydralazine
penicillin
isoniazid
chemotherapy
List metabolic causes of acute pericarditis
uraemic
hypothyroidism
anorexia nervosa
What are the clinical features of acute pericarditis?
Central chest pain - worse on inspiration and lying flat; relieved by bending forward
Pericardial friction rub
What investigations would you do for a suspected acute pericarditis?
ECG
Bloods
- FBCs
- ESR
- U&E
- cardiac enzyme = troponin may be raised
CXR
- may show cardiomegaly = could indicate a pericardial effusion
Echo
- if pericardial effusion is suspected
CMR (cardiac MRI) & CT
- may show localised inflammation
What findings may you see on ECG for an acute pericarditis?
Widespread ST elevation (as opposed to a STEMI which would have ST elevation in specific heart regions)
Saddle-shaped ST elevation
PR depression
Could also be normal or non-specific (10%)
What is the Mx of acute pericarditis?
NSAIDs or aspirin with gastric protection for 1-2 weeks
Add colchicine 500mcg OD/BD for 3 months to reduce risk of recurrence
Rest until symptoms resolve - it’s ok to send them home
Treat the cause
If not improving or autoimmune consider steroids (may increase the risk of recurrence) or other immunosuppressive drugs
What is constrictive pericarditis?
Heart is encased in a rigid pericardium
What are the causes of constrictive pericarditis?
In UK often unknown
Other places in the world = TB
After any pericarditis
What are the clinical features of constrictive pericarditis?
Right sided HF with increased JVP
Kussmaul’s sign (JVP rises paradoxically with inspiration)
Soft, diffuse, apex beat
Quiet heart sounds
S3 diastolic pericardial knock
Hepatosplenomegaly
Ascites
Oedema
What Ix would you do for constrictive pericarditis?
CXR - small heart +/- pericardial calcification
CT/MRI helps to distinguish from restrictive cardiomyopathy
Echo - cardiac catheterisation
