Pericarditis 2 Flashcards
What is pericarditis?
Inflammation of the pericardium, the membrane surrounding the heart.
What can cause pericarditis?
Idiopathic
Infection (e.g., tuberculosis, HIV, coxsackievirus, Epstein–Barr virus and other viruses)
Autoimmune and inflammatory conditions (e.g. SLE and rheumatoid arthritis)
Injury to the pericardium (e.g., after myocardial infarction, open heart surgery or trauma)
Uraemia (raised urea) secondary to renal impairment
Cancer
Medications (e.g., methotrexate)
What is a pleural effusion?
Potential space of the pericardial cavity fills with fluid.
What does a cardiac pleural effusion cause?
Inward pressure on the heart, making it more difficult to expand during diastole (filling of the heart).
What is pericardial tamponade?
Pericardial effusion is large enough to raise the intra-pericardial pressure.
Increased pressure squeezes the heart and affects its ability to function.
It reduces heart filling during diastole, decreasing cardiac output during systole.
This is an emergency and requires prompt drainage of the pericardial effusion to relieve the pressure.
Two key presentations that make you think of pericarditis
Chest pain
Low-grade fever
Chest pain is:
Sharp
Central/anterior
Worse with inspiration (pleuritic)
Worse on lying down
Better on sitting forward
Clinical findings
Pericardial rub on auscultation
Blood test results
Raised inflammatory markers (white blood cells, CRP and ESR).
ECG changes
Saddle-shaped ST-elevation
PR depression
Downward slope of T-P line
Management
Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment (e.g., aspirin or ibuprofen)
Colchicine (taken longer-term, e.g., 3 months, to reduce the risk of recurrence)
Second line management
Steroids
When is pericardiocentesis required?
If there is a significant pericardial effusion or tamponade
