Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium
Acute: Fibrinous, Purulent, Caseous (TB)
Chronic: Constrictive, Effusive-constrictive

Question 2

List 4 symptoms of pericarditis

Answer 2

Sharp, severe retrosternal chest pain worse with inspiration + when lying flat
Dyspnoea
Nausea
Myalgia

Question 3

What are 7 causes of pericarditis?

Answer 3

IDIOPATHIC
Infective
Connective tissue disease (e.g. sarcoidosis, SLE)
Post-MI (< 24-72 hrs= up to 20% of pts)
Dressler’s Syndrome: pericarditis weeks/months after acute MI
Malignancy: lung, breast, lymphoma, leukaemia
Radiotherapy

Question 4

What are 5 common causative organisms in infective pericarditis?

Answer 4

Coxsackie B  
Mumps  
Streptococci 
Staphylococci 
TB

Question 5

List 3 signs of pericarditis

Answer 5

Fever
Pericardial friction rub (Heard best at lower LSB, with pt leaning forward during expiration)
HS may be faint due to a pericardial effusion

Question 6

List 3 signs of cardiac tamponade

Answer 6

Beck’s Triad (signs associated with acute cardiac tamponade)
Tachycardia
Pulsus paradoxus

Question 7

What is Beck’s triad?

Answer 7

Raised JVP
Low BP
Muffled Heart Sounds

Question 8

What is cardiac tamponade?

Answer 8

Accumulation of blood, fluid, pus, clots, or gas in the pericardial space, resulting in reduced ventricular filling

Question 9

List 5 risk factors for pericarditis

Answer 9

Male sex
Age 20- 50
Transmural MI
Cardiac surgery
Viral/ bacterial infection

Question 10

What is pulses paradoxus?

Answer 10

Abnormally large decrease in SBP (> 10 mmHg) + pulse wave amplitude during inspiration

Question 11

What bedside investigations are appropriate for pericarditis? What would be seen?

Answer 11

ECG:
Widespread concave “saddle shaped” ST elevation + PR depression (I, II, III, aVF, V4-6)
Reciprocal ST depression + PR elevation in V1 + aVR

Question 12

What blood investigations are appropriate for pericarditis?

Answer 12

FBC (Elevated WCC indicates infectious cause)
U+Es (urea elevated if uraemic cause)
ESR/ CRP (elevated)
Serum troponin (normal/ elevated) 
Blood cultures (+ve if infective cause)

Question 13

What radiological investigations are appropriate for pericarditis?

Answer 13

CXR:
Usually normal
If large pericardial effusion, cardiothoracic ratio increases

Question 14

What other investigations are appropriate for pericarditis?

Answer 14

Echocardiogram - assesses pericardial effusion + cardiac function
Excludes ACS

Question 15

What is the acute management plan for pericarditis if in cardiac tamponade, purulent/ neoplastic pericarditis or symptomatic effusion?

Answer 15

Emergency pericardiocentesis

Question 16

What is the medical management plan for pericarditis?

Answer 16

Treat underlying cause  
NSAIDs (pain + fever relief)  + PPI (gastric protection)
Colchicine
Exercise restriction
\+ anti-virals if appropriate

Question 17

What is the 2nd and 3rd line medical management plan for recurrent pericarditis? (1st line is as medical management)

Answer 17

2: Low-dose corticosteroid
3: Immunosuppressants

Question 18

What is the surgical management plan for pericarditis?

Answer 18

Pericardiectomy

Question 19

List 3 complications of pericarditis

Answer 19

Pericardial effusion
Cardiac tamponade
Chronic constrictive pericarditis

Question 20

What is the prognosis differ in pericarditis?

Answer 20

Pericarditis is a self-limiting disease without significant complications/ recurrences in 70-90% of patients

Question 21

What is important about the age group that this cause of chest pain can present in?

Answer 21

May present in the YOUNG