Pericarditis Flashcards
Pericarditis: definitions
Acute pericarditis is inflammation of the pericardium, a fibroelastic sac surrounding the heart.
Inflammation can also extend to the myocardium, in which case the condition is referred to as perimyocarditis or myopericarditis depending on which is predominant
Causes of pericarditis: general categories (7)
IMCRDtRO
- Infective causes
- Malignant causes
- Cardiac causes
- Radiation - secondary to therapy for other malignancies
- Drugs and toxin causes
- Rheumatological disease
- Other causes
Causes of pericarditis: infective
Viruses (CCEHH) - viruses which cause pericarditis are coxsackie, CMV, echovirus, herpesvirus, HIV
Bacteria - staphylococcus, pneumococcus, streptococcus (rheumatic carditis), haemophilus and M. tuberculosis.
Fungi and parasites (rare)
Causes of pericarditis: Malignancy
Lung cancer
Breast cancer
Hodgkin lymphoma
Causes of pericarditis: Cardiac causes
Heart failure
Post-cardiac injury syndrome (Dressler’s syndrome) including post-trauma
Causes of pericarditis: drugs and toxins
Anthracycline chemotherapy (Doxorubicin)
Hydralazine
Isoniazid
Methyldopa
Phenytoin
Penicillins (hypersensitivity)
Causes of pericarditis: Rheumatological disease
Systemic lupus erythematous (SLE)
Rheumatoid arthritis
Sarcoidosis
Vasculitides (Takayasu’s, Behcet’s)
Causes of pericarditis: other
Renal failure (uraemia)
Hypothyroidism
Inflammatory bowel disease
Ovarian hyperstimulation
CT disease
Clinical features of pericarditis
Chest pain (usually pleuritic and worse on lying flat) –> Is often relieved by sitting forwards
Fever
Pericardial friction rub
ECG changes
- Widespread SADDLE-SHAPED ST elevation
- PR depression
Raised troponin
ECG changes in pericarditis
1-3 weeks: normalisation of ST changes, T wave flattening
3-8 weeks: flattened T waves become inverted
8+ weeks: ECG returns to normal
Pericarditis: diagnosis
CLINICAL, but
ECG
Troponin (tends not to peak like MIs but instead stays constantly elevated in the acute phase)
ECHO - ?pericardial effusion
Angiogram - shows normal coronary arteries (which excludes MI)
Pericarditis: management
A. What to do in recurrent cardiac tamponade OR adhesions
1st line –> exercise restriction + NSAIDs + colchicine (caution in patients with renal or hepatic impairment)
2nd line –> corticosteroids if:
1. unable to tolerate NSAIDs
2. non viral pericarditis (due to the risk of re-activation) and once infection has been ruled out
Bacterial –> IV antibiotics +/- pericardiocentesis (if purulent exudate present)
A. Pericardectomy
Complications of pericarditis
Rare, but include
- cardiac tamponade + pericardial effusion requiring pericardiocentesis.
Long term –> constrictive pericarditis
What is constrictive pericarditis
1. Why is it ‘constrictive’
scarring and loss of elasticity of the pericardial sac
1. upper limit of cardiac volume is constrained by the rigid pericardium, which prevents normal cardiac filling –> reduced SV and CO
Epidemiology of Constrictive Pericarditis
often idiopathic, but can also occur after any pericardial disease process such as previous acute pericarditis (incidence in this demographic is 1.8%).
