Pericarditis Flashcards
What is acute pericarditis?
Inflammation of the pericardium; it may occur with or without pericardial effusion.
What changes would you expect to see on an ECG?
- Saddle-shaped ST segment elevation.
- PR depression
- T wave inversion
May be normal or non-specific.
What investigations do you perform for pericarditis?
- ECG - saddle-shaped ST elevation
- Bloods - FBC, U&Es, ESR/CRP, cardiac enzymes (trop may be raised), viral serology, blood cultures, autoAbs if indicated (AHA, AIDA, ASOT, RhF, ANA).
- CXR - normal if uncomplicated; globular heart if large pericardial effusion
- Echo to exclude large pericardial effusion
What are the differentials for pericarditis?
- MI or ischaemic heart disease
- Pleuritic chest pain
- Pulmonary infarction
- PUD or oesophagitis
What are the causes of acute pericarditis?
- Idiopathic
- Viruses
- Bacteria
- Fungi
- MI - Dressler’s
- Drugs
- Inflammatory diseases - RA, SLE, connective tissue disorders
- Uraemia, myxoedema, surgery, malignancy (and anti-neoplastic agents), radiotherapy , sarcoidosis
- Haemopericardium (trauma, aortic dissection)
What are the most common viral causes of pericarditis?
- Coxsackie virus
- Flu
- EBV
- Mumps
- Varicella
- HIV
What are the most common bacterial causes of pericarditis?
- Pneumonia
- Rheumatic fever
- TB
- Staphs
- Streps
- MAI in HIV
What is Dressler’s syndrome?
A form of secondary pericarditis that is the result of injury to the heart or pericardium.
It consists of pleuritic pain, pericarditis, anaemia, fever and/or a pericardial effusion.
Which drugs can cause pericarditis?
- Procainamide
- Hydrazine
- Penicillin
- Cromolyn sodium
- Isoniazid
What signs and symptoms would you see in pericarditis?
Pericardial pain - relieved on leaning forward and worse on inspiration or lying flat.
Symptoms of pericardial effusion if present.
Pericardial friction rub - a rough scratching noise, accentuated by the patient leaning forwards.
How do you manage pericarditis?
- Analgesia with an NSAID e.g. ibuprofen 400mg/8h PO with food.
- Corticosteroid in autoimmune pericarditis; consider colchicine before steroids if relapse or continuing symptoms occur as steroids may increase the risk of recurrence.
- Treat the precipitating cause.
What are the clinical features of acute pericarditis?
Central chest pain worse on inspiration or lying flat.
Relief of chest pain on lying down.
Pericardial friction rub may be heard.
Look for evidence of pericardial effusion or cardiac tamponade.
