Pericarditis

Question 1

What is pericarditis ?

Answer 1

• The area around the heart is inflamed.
• At risk of developing pericardial effusion – This is where the inflammation causes fluid to collect around the heart.

Question 2

Explain pericarditis in detail

Answer 2

The inner layer of the pericardium is called the severe pericardium; the outer is called the fibrous pericardium. Within this area is the pericardial cavity, filled with fluid and lets the heart “slip” around. The cells of the serous pericardium secrete and reabsorb the fluid – Usually, there are no more than 50 MLS in the pericardial cavity at one time.

Inflammation in the pericardium means that fluid and immune cells move from tiny blood vessels in the serious and fibrous pericardium and into the tissue, making it thicker. This can result in the serious pericardium not being removed as quickly as it is coming in so. Therefore, the fluid can pool out into the pericardial space. This can put pressure on the heart, stopping it from pumping correctly and can lead to cardiac tamponade and a medical emergency.

Question 3

What can pericarditis lead to ?

Answer 3

Cardiac tamponade due to pericardial effusion.

Can lead to constrictive pericarditis – Persistent pericarditis can become fibrotic due to the presence of immune cells thickening and stiffening the area – this is a gradual thing.

It can lead to recurrent pericarditis – 20 – 30 % of patients.

Question 4

What can cause Pericarditis

Answer 4

Most commonly Virus

Virus
- Herpes virus eg EBV
- Enterovirus eg coxsackie
- Parvovirus B19 - Possible overlap with aetiology of myocarditis.
- Adenovirus

Rarely

Bacteria

Common – Mycobacterium tuberculosis
Rare – Staphylococcus aures.

Question 5

What are the symptoms of pericarditis ?

Answer 5

Symptoms
- Fever
- Chest pain due to heart rubbing due to inflammation
- Chest pain that’s worse on heavy breathing.
- Chest pain is better sitting up and leaning forward.

Symptoms of Large pericardial effusions >100 ml
- Diminished heart sounds
- Decreased cardiac output leads to shortness of breath (SOB), low blood pressure and light-headedness.

Question 6

How to diagnose pericarditis ?

Answer 6

• St-segment elevation and pr depressions in the first couple of days.
• After this, T waves become inverted.
• Eventually, the ECG returns to normal.
• Pericarditis can show low QRS voltage (low height)
• Xray
• Echo
• Inflammation markers – CRP, ESR, WBC
• PCR for TB?

Question 7

How to treat pericarditis ?

Answer 7

Treatment
- Pain relief
- Rest
- NSAIDS
- Aspirin
- Colchicine – inhibits neutrophil migration. This is for ACUTE cases and recurrent.
- Pericardiocentesis – if severe signs of cardiac tamponade
- Constrictive pericarditis might need pericardiectomy.

Bacterial
- This is rare; however, if TB causes it, start antibiotics.