Pericarditis

Question 1

2 MC causes of pericarditis

Answer 1

idiopathic and viral (esp Coxsackieviruses A and B and echovirus)

Question 2

Dressler syndrome

Answer 2

post MI pericarditis + fever + pleural effusion that may occur after several weeks after the MI

Question 3

Sx pericarditis

Answer 3

sudden onset of pleuritic (star, worse with deep inspiration or coughing) anterior chest pain that is often persistent and positional - worse when supine and improved w the seated position or by leaning forward

pain may radiate to shoulder and trapezius ridge, back, neck, arm, epigastric

pericardial friction rub - often best heard at the left parasternal area and the intensity may be increased during auscultation by having the patient sitting up and leaning forward or resting the elbows on the knees, applying firm pressure on the stethoscope diaphragm during suspended respiration.

Question 4

EKG for pericarditis

Answer 4

precordial leads - widespread diffuse (typically concave up) ST segment elevation in V1-V6 with associated PR depression in those leads and without reciprocal T-wave inversions or Q waves

PR segment deviation is highly specific

Lead aVR - associated w reciprocal ST depression and PR elevation

Question 5

in pericarditis, what can you use to evaluate for associated pericardial effusion and/or signs of cardiac tamponade

Answer 5

echocardiogram

Question 6

tx pericarditis

Answer 6

high-dose NSAIDs or aspirin
Colchicine second line or first line as mono therapy or in conjunction w Aspirin or NSAIDs
Glucocorticoids if refractory or severe

Question 7

tx Dressler syndrome

Answer 7

Aspirin and/or colchicine (avoid NSAIDs)