Pericarditis

Question 1

Define pericarditis

Answer 1

Inflammation of the pericardium
Acute <6 weeks: fibrinous, effusive
Subacute 6 weeks - 6 months
Chronic >6 months: constrictive, effusive

Question 2

What are the causes/risk factors of pericarditis?

Answer 2

• Idiopathic
• Infection e.g. coxsackie B, mumps, Streptococcus spp., Staphylococcus spp., TB
• Connective tissue disease e.g. sarcoidosis, SLE, scleroderma
• Post-MI
• Dressler’s syndrome
• Malignancy
• Hypothyroidism
• Uraemia
• Radiotherapy
• Thoracic surgery
• Drugs e.g. hydralazine, isoniazid

Question 3

What are the symptoms of pericarditis?

Answer 3

• Pleuritic chest pain – worse on inspiration, lying back; relieved by sitting forward
• SOB
• Nausea

Question 4

What are the signs of pericarditis/

Answer 4

• Fever
• Pericardial rub
• Faint heart sounds – pericardial effusion

Cardiac tamponade
• Beck’s triad: (↑JVP, ↓BP, muffled heart sounds)
• Tachycardia
• Pulsus paradoxus

Constrictive pericarditis
• Kussmaul’s sign (↑JVP with inspiration)
• Pulsus paradoxus
• Hepatomegaly
• Ascites
• Oedema
• Pericardial knock

Question 5

What investigations are carried out for pericarditis?

Answer 5

• ECG - widespread saddle-shaped ST elevation
• Echocardiogram - assesses pericardial effusion and cardiac function
• Bloods
- FBC
- U&Es
- ESR/CRP
- Cardiac Enzymes (usually normal)
- Other investigations for cause: blood cultures, ASO titres, ANA, rheumatoid factor
• CXR
- Usually normal
- May be globular if there is a pericardial effusion

Question 6

What is the management for pericarditis?

Answer 6

Acute
• cardiac tamponade is treated with emergency pericardiocentesis
Medical 
• Treat underlying cause 
• NSAIDs for pain and fever relief 

Recurrent
• Low-dose steroids
• Immunosuppressants
• Colchicine

Surgical
• Pericardiectomy is performed in cases of constrictive pericarditis

Question 7

What are the complications of pericarditis?

Answer 7

• Pericardial effusion
• Cardiac tamponade
• Cardiac arrhythmias