Pericarditis

Question 1

Define

Answer 1

DEFINITION: inflammation of the pericardium

It may be acute, subacute or chronic

Question 2

Epidemiology

Answer 2

UNCOMMON

< 1/100 hospital admissions

More common in males

Question 3

Causes

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

Symptoms

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

Signs

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

Question 6

Constrictive pericarditis

Answer 6

Kussmaul’s sign: raise of JVP on inspiration

Pulsus paradoxus

Hepatomegaly

Ascites

Oedema

Pericardial knock (due to rapid ventricular filling)

AF

Question 7

Cardiac tamponade

Answer 7

Beck’s Triad (signs associated with acute cardiac tamponade)

1. Raised JVP
2. Low Blood Pressure
3. Muffled Heart Sounds

Tachycardia

Pulsus paradoxus Definition: an abnormally large decrease in SBP (> 10 mm Hg drop) and pulse wave amplitude during inspiration

Question 8

Investigations

Answer 8

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 9

Management

Answer 9

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 10

Complications

Answer 10

Pericardial effusion

Cardiac tamponade

Cardiac arrhythmias

Question 11

Prognosis

Answer 11

Depends on the underlying cause

Viral cases have a GOOD prognosis

Malignant pericarditis has a POOR prognosis