Pericarditis

Question 1

Causes of pericarditis

Answer 1

• Idiopathic
• Viral infection
• Bacterial infection
• Autoimmune disease (e.g. RA, SLE)
• Renal failure - uraemia
• Neoplasm
• MI - Dressler’s syndrome (after 2-3 weeks)

Question 2

Symptoms of pericarditis

Answer 2

• Pleuritic chest pain:
  
  • Quality and intensity may vary
  • Radiates to trapezius edge, neck, left shoulder or left arm
  • Worse lying flat or moving
  • Relieved by leaning forwards
• Dyspnoea
• Cough

Question 3

Signs of pericarditis

Answer 3

• Friction rub:
  
  • Best heard at left sternal edge, leaning forwards
• Low-grade fever

Question 4

Investigations for pericarditis

Answer 4

• ECG - global upwardly concave ST elevation, PR depression
• Bloods:
  
  • FBE - elevated WCC
  • UEC - uraemic cause, risk of arrhythmias
  • ESR, CRP - elevated
  • Troponin - associated myocarditis or MI
• CXR:
  
  • Enlarged, globular cardiac silhouette - large pericardial effusion/cardiac tamponade

Question 5

Management of pericarditis

Answer 5

• NSAID
  
  • Colchicine
    
    • Corticosteroids