Pericarditis

Question 1

Define:

Answer 1

Inflammation of the pericardium (can be acute, subacute or chronic)

Question 2

Aetiology/risk factors:

Answer 2

Idiopathic

Infective:

• mumps
• staphy
• strep
• TB
• Coxsackie B
• echovirus

Connective tissue - scleroderma, sarcoidosis and SLE

Post-Mi - 20% of patients or Dessler’s - this is weeks to months post MI

Malignancy - breast, lung, lymphoma, melenoma, leukaemia

Radiotherapy

Rheumatoid arthritis

Uraemia

Question 3

Symptoms:

Answer 3

Chest pain:

• pleuritic in nature
• sharp and central
• worse lying down
• better sitting forward
• radiate to neck and shoulders

Nausea

Dysponea

Question 4

Signs:

Answer 4

Tachycardia

Fever

PERICARDIAL FRICTION RUB (heard better sitting forwards and on expiration by the lower left sternal edge)

faint HS

cardiac tamponade signs - low BP, raised JVP and muffled HS

pulsus paradoxus - decrease SBP >10mmHg on inspiration

Question 5

Investigations:

Answer 5

ECG - saddle shaped ST elevations, T wave flattening and eventual inversion, PR depression and tachycardia.

Pericardial effusion on ECG will show variant QRS complex sizes

Bloods -FBC - WCC will be high if infective, cardiac enzymes should be normal, U+E’s, ESR/CRP

Blood cultures - RF, viral serology, ANA, ASO

CXR - usually normal

Question 6

Epidemiology:

Answer 6

UNCOMMON

Less than 1/100 hospital admissions

more common in males

Question 7

Management:

Answer 7

If cardiac tamponade then emergency pericardicentesis

Medical - treat the cause, analgesia (NSAIDs and Aspirin +/- Colchicine (reduces fibrosis and neutrophil infiltration)
-may give PPIs to stop gastric irritation

Recurrent:

• low dose steroids
• colchicine
• immunosuppresants

Question 8

Complications:

Answer 8

pericardial effusion

cardiac arrythmias

cardiac tamponade

Question 9

prognosis:

Answer 9

depends on the cause

viral have a good prognosis where malignancy has a poor prognosis

15-40% recur