Pericarditis

Question 1

Describe the chest pain in pericarditis

Answer 1

Sharp, pleuritic central chest pain which is worse on inspiration and lying down but is improved by sitting forward

Question 2

What can be heard on auscultation of a patient with pericarditis?

Answer 2

Pericardial friction rub, a superficial scratching sound not confined to diastole or systole

Question 3

Which two conditions should you also be looking for the signs of in a patient with suspected pericarditis?

Answer 3

Pericardial effusion and cardiac tamponade

Question 4

What tests would you perform in a patient with suspected pericarditis?

Answer 4

ECG
FBC, ESR, U&Es, troponin
CXR

Question 5

What are the classic ECG changes in pericarditis?

Answer 5

Widespread saddle shaped ST elevation +/- PR depression

Question 6

Would troponin be raised in pericarditis?

Answer 6

Maybe

Question 7

What is the management of pericarditis?

Answer 7

NSAIDS/Aspirin for 3 weeks, plus PPI for gastric protection
Colchicine for 3 months
Treat underlying cause 
Rest until symptoms subside
Consider steroids or immunosupression

Question 8

Name 5 causes of pericarditis.

Answer 8

Any 5 from:

• Idiopathic
• Viral - coxsackie, flu, EBV, HIV
• Bacterial - pneumonia, TB, rheumatic fever, staphs
• Fungi - usually rare
• Autoimmune - SLE, RA, IBD, sarcoid, Dressler’s, Behçet
• Drugs - isoniazid, penicillin
• Metabolic - uraemia, hypothyroidism
• Other - Trauma, MI, radiotherapy, malignancy, surgery

Question 9

What is Dressler syndrome?

Answer 9

Also called postmyocardial infarction syndrome, it is autoimmune pericarditis following an MI. It is caused by autoantibodies against the myocyte sarcolemma.