Pericarditis

Question 1

What is the definition of pericarditis?

Answer 1

Inflammation of the pericardium

It may be acute, subacute or chronic

Question 2

What is the aetiology of pericarditis?

Answer 2

UNCOMMON

< 1/100 hospital admissions

More common in males

Question 3

What is the epidemiology of pericarditis?

Answer 3

IDIOPATHIC

Infective

Most common causative organisms:

• Coxsackie B
• Echovirus
• Mumps
• Streptococci
• Fungi
• Staphylococci
• TB

Connective tissue disease (e.g. sarcoidosis, SLE, scleroderma)

Post-MI (within 24-72 hrs of MI - occurs in up to 20% of patients)

Dressler’s Syndrome - pericarditis occurring weeks/months after acute MI

Malignancy - lung, breast, lymphoma, leukaemia, melanoma

Radiotherapy

Thoracic surgery

Drugs (e.g. hydralazine, isoniazid)

Question 4

What are the presenting symptoms of pericarditis?

Answer 4

CHEST PAIN

• Sharp and central
• May radiate to the neck or shoulders
• Worse when coughing and deep inspiration (pleuritic pain)
• Relieved by sitting forward

Dyspnoea

Nausea

Question 5

What are the signs of pericarditis upon physical examination?

Answer 5

Fever

Pericardial friction rub = Heard best at lower left sternal edge, with patient leaning forward during expiration

Heart sounds may be faint due to a pericardial effusion

Cardiac Tamponade signs 
-> Beck's Triad (signs associated with acute cardiac tamponade) 
- Raised JVP 
- Low Blood Pressure  
- Muffled Heart Sounds  
-> Tachycardia 
-> Pulsus paradoxus  
Definition: an abnormally large decrease in SBP (> 10 mm Hg drop) and pulse wave amplitude during inspiration 

Constrictive Pericarditis signs

Question 6

What are the signs of constrictive pericarditis?

Answer 6

Kussmaul’s sign

Pulsus paradoxus

Hepatomegaly

Ascites

Oedema

Pericardial knock (due to rapid ventricular filling)

AF

Question 7

What are the appropriate investigations for pericarditis?

Answer 7

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 8

What is the management plan for pericarditis?

Answer 8

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 9

What are the possible complications of pericarditis?

Answer 9

Pericardial effusion

Cardiac tamponade

Cardiac arrhythmias

Question 10

What is the prognosis for patients with pericarditis?

Answer 10

Depends on the underlying cause

Viral cases have a GOOD prognosis

Malignant pericarditis has a POOR prognosis