Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium

Question 2

Infectious causes of pericarditis?

Answer 2

Viral- mainly echoviruses, viruses produce serous effusions

Bacterial - enter pericardium from infection somewhere via the bloodstream e.g. pneumonia.

Fungi - immunosuppressed patients, produce purulent effusions.

Tuberculosis - caseous material in pericardial sac

Question 3

Other causes of pericarditis?

Answer 3

Immune mediated - rheumatic fever

Idiopathic

Uraemic (renal failure)

Connective tissue disorder e.g. SLE

Question 4

Symptoms of pericarditis?

Answer 4

Pleuritic chest pain

• Worse on inspiration
• Relieved by sitting up

Question 5

Signs of pericarditis?

Answer 5

Low grade fever

Pericardial friction rub (a grating, to-and-fro sound produced by friction of the heart against the pericardium).

Question 6

Investigations for pericarditis?

Answer 6

ECG: saddle shaped ST elevation

Bloods:
- Troponin levels may be slightly elevated.
- Raised inflammatory markers
- Viral serology may identify cause.

Question 7

1st line management of bacterial pericarditis?

Answer 7

IV antibiotics +/- pericardiocentesis if purulent exudate present

Question 8

1st line management of viral or idiopathic pericarditis?

Answer 8

Exercise restriction and NSAIDS (+PPI for stomach protection) for 1-2 weeks

Question 9

Complications of pericarditis?

Answer 9

Pericardial effusion

Tamponade

Constrictive pericarditis

Cardiac failure

Death