Pericarditis

Question 1

Definition

Answer 1

Inflammation of pericardium +/- effusion (typically acute - can be chronic )

Question 2

Typical patient?

Answer 2

Male 20-50

Question 3

Causes?

Answer 3

Idiopathic (mostly)
Infections = viral (coxsackie B virus)
Bacteria (TB - strep pneumoniae, staph aureus)
Fungal - rare - histoplasmosis, immunocompromised patient

Non infectious
Dressler’s syndrome- post MI
Autoimmune- SLE, Sjorgen’s, RA (common)
Neoplastic (lung, breast)

Question 4

Pathology of pericarditis

Answer 4

Inflamed pericardial layers rub against each other (as narrowed pericardial space narrowed with inflammation)& exacerbate further inflammation

This may remain dry (no extra fluid; not as bad, don’t end to compensate for friction) or become effusive (extra fluid needed to compensate for friction )

Question 5

Signs and symptoms of pericarditis

Answer 5

Severe sharp chest pain radiating to left shoulder tip (trapezius ridge - phrenic) / neck, shoulders, back
Worse lying flat or taking a deep breath
Relieved by sitting up & leaning forwards

Pericardial friction rub in auscultation- heard when patient leans forwards, squeaky leather to and fro sound

Question 6

What is constructive pericarditis? (Chronic)

Answer 6

Visceral pericardium becomes more fibrous (granulation tissue formation) - becomes more stiff, impairs diastolic filling - late complication of acute pericarditis + sign of poor heart prognosis

Harder for hearts to fill with blood = low CO = heart failure (RHS) - increased pulmonary BP Fluid in lungs, increased blood in venous circulation

Question 7

Diagnosis of pericarditis

Answer 7

ECG (diagnostic) = widespread saddle shaped ST elevation, PR depression
Chest x ray = may show ‘water bottle’ heart (cardiomegaly) or pneumonia commonly seen (bacterial pericarditis - TB)

High ESR = seen in autoimmune
High WCC (white cell count) = in infection

Question 8

What is the most key rule out disease?

Answer 8

MI
Central crushing chest pain not related to lying down, no pericardial rub

Question 9

Treatment for idiopathic or viral cause

Answer 9

NSAIDS eg. Aspirin for 2 weeks
Colchicine (anti inflammatory) for 2 weeks

Question 10

Treatment for bacterial

Answer 10

Antibiotics if bacterial (RIPE for TB)

Question 11

Complications?

Answer 11

Pericardial effusion = cardiac tamponade, myocarditis, constrictive pericarditis