Pericarditis

Question 1

Causes

Answer 1

Idiopathic
Infective
Uremic (renal failure)
Neoplastic
Connective tissue disease 
Immune disease
Post MI 
Post cardiac surgery
Dressler Syndrome

Question 2

What is dressler’s syndrome?

Answer 2

Pericarditis 2-10 weeks post MI

Question 3

Signs and symptoms

Answer 3

Pleuritic sharp central CP
Fever/flu if viral
Pericardial rub heard (like someone walking on snow)
Signs of tamponade

Question 4

What connective disorders can cause pericarditis?

Answer 4

Sarcoid, SLE, scleroderma

Question 5

What would you see on ECG?

Answer 5

Widespread saddle shaped S elevation

PR prolongation

Question 6

Infective causes

Answer 6

Pneumococcal, TB<

Coxsackie B, Herpes, Staph

Question 7

When might pericarditis arise post MI?

Answer 7

24-72hrs

Question 8

At what time frame do you call in Dressler syndrome?

Answer 8

2*10 weeks

Question 9

What makes it better?

Answer 9

Sitting forward

Question 10

Name some complications of pericarditis

Answer 10

Cardiac Tamponade
Hepatomegaly secondary to RHF 
Peripheral oedema 
(Chronic effusive pericarditis)
Restrictive pericarditis
Chronic heart failure

Question 11

Investigations for cardiac tamponade?

Answer 11

Echo cardiogram - shows fluid and the heart swings

Question 12

If a patient comes in with chest pain after a cold, what could they have?

Answer 12

pericarditis

Question 13

ECG findings for pericarditis

Answer 13

Fake ST elevation (below J line), also known as ‘saddle shaped’

Question 14

What might be elevated in pericarditis and why?

Answer 14

Troponin - might be due to myopericarditis or because someone had a silent MI a few days previously

Question 15

Myocarditis vs pericarditis

Answer 15

Myocarditis - inflammation of the heart muscle

Pericarditis - inflammation of the surrounding tissue

Question 16

Why do you do an echo?

Answer 16

To check for pericardial effusion

Note: if this is severe enough to affect the heart, it is called cardiac tamponade

Question 17

Treatment of choice for pericarditis

Answer 17

NSAIDS

Question 18

What would be elevated in cardiac tamponade?

Answer 18

JVP would be raised to angle of jaw

Question 19

Most common cause of pericarditis

Answer 19

Viral

Question 20

How accurate are ECG findings in pericarditis?

Answer 20

ECG findings are non-specific and may be normal in about 10%

Question 21

What is the recurrence rate of pericarditis?

Answer 21

Acute pericarditis may recur in up to 30% of patients

Question 22

How do you perform pericardiocentesis?

Answer 22

In pericardiocentesis, the needle is inserted subcostally in the midline aiming towards the left shoulder.

Question 23

Investigations for pericarditis

Answer 23

Serial ECGs
Repeat cardiac enzymes (to exclude MI)
Echo potentially

Question 24

Epidemiology

Answer 24

Young person

Question 25

Differentials for saddle shaped ST elevation

Answer 25

STEMI can also cause saddle shaped MI