Pericarditis

Question 1

Aetiology of pericarditis

Answer 1

Viruses e.g. coxsackie, echovirus, EBV, CMV, adenovirus, mumps, varicella,
Autoimmune e.g. SLE, RA, systemic sclerosis, reactive arthritis, sarcoid, amyloid
Bacteria e.g. TB (most common cause worldwide, Lyme, pneumonia, rheumatic fever, staphs, streps
Fungi and parasitic
Post-MI
Drugs e.g. procainamide, hydralazine, penicillin, isoniazid
Metabolic e.g. uraemia, hypothyroidism
Other e.g. trauma, surgery, malignancy, radiotherapy

Question 2

risk factors for pericarditis

Answer 2

Male
20-50
Transmural MI
Cardiac surgery
Neoplasm
Viral and bacterial infections
Uraemia or on dialysis
Systemic autoimmune disorders
(pericardial injury, mediastinal radiation)

Question 3

Symptoms of percarditis

Answer 3

Chest pain - Central, worse lying flat or on inspiration, relieved by sitting forward
Flu-like symptoms: fever, malaise
Dry cough
Dyspnoea
Often preceded by URTI

Question 4

Investigations for pericarditis

Answer 4

ECG: PR depression, widespread saddle-shaped ST Elevation

FBC: raised WCC
CRP/ESR: raised
TFTs: ?hypothyroid
Troponin: ?MI
U&Es: ?ureaemia
Blood cultures: ?infection

Echo: ?tamponade/effusion
CXR: normal or cardiomegaly

Question 5

Management for pericarditis

Answer 5

NSAIDS or aspirin + gastric protection (PPI) for 1-2 weeks e.g. ibuprofen 600mg orally every 8 hours for 1-2 weeks + omeprazole 20mg orally once daily
Colchicine 500mcg OD or BD for 3 months to reduced recurrence risk
Rest until symptoms resolve
Consider steroids or immunosuppressants
Treat the cause

Tamponade → pericardiocentesis

Question 6

Complications of pericarditis

Answer 6

Pericardial Effusion: dyspnoea, chest pain, hiccups (phrenic nerve), nausea (diaphragm), bronchial breathing left base (lower lobe)
Constrictive pericarditis: RHF, soft/diffuse apex beat, pericardial knock - requires surgical excision
Cardiac tamponade: tachycardia, hypotension, pulsus paradoxus, raised JVP, muffled heart sounds

Question 7

Prognosis for pericarditis

Answer 7

Usually a self-limited disease in 70-90% patients, with no significant complications or recurrence.
Purulent pericarditis is uniformly fatal if untreated (mortality 40% with treatment)
Uraemic pericarditis generally responds to intensive dialysis. Effusions are common with neoplastic pericarditis and are often recurrent and difficult to manage