(!) Pericarditis

Question 1

Define acute pericarditis

Answer 1

acute
Inflammation of the pericardium secondary to other causes (infections, IHD, drugs, auto-immune )

either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate

chest pain, pericardial friction rub, and serial electrocardiographic changes

differentiate from constrictive pericarditis (often after acute pericarditis)

Question 2

aetiology of acute pericarditis

Answer 2

90% are viral or idiopathic
(coxsackle, flu, mumble, HIV)

other 10%-bacteria, MI
Drugs-penicillibm hydralazine
RA, SLE, sarcoidosis, ureamia (dyalisis)

More common between 20-50 and in MEN

Question 3

Epidemology of acute pericarditis

Answer 3

More common between 20-50, men

could make up to 5% of A&E presentation-uncertain

Question 4

Symptoms of acute pericarditis

Answer 4

CHEST PAIN-worse with inspiration and lying flat
lasts a few days (not MI length)

FEVER, myalgia,
can have signs of RHF

Question 5

Signs of acute pericarditis

Answer 5

Pericardial friction rub-squeak as they breath
best hear at left sternal angle and breath

Evidence of pericardial effusion (raised JVP, 
Cardiac tamponade (pulse UP, bp low, JVP up, Kussmails sign, muffles S1 and S2)

Question 6

tests for acute pericarditis

Answer 6

ECG-classical SADDLE SHAPED ST SEGMENT, ST elevation

Bloods- Trop can be high
want FBC (WBC), ESR, VIRAL SEROLOGY, blood cultures, TFT's

CXR-cardiomegaly can indicate pericardial EFFUSION

Echo-if effusion/contrictive

Question 7

management of Pericarditis

Answer 7

act based on risk factors-high fever, tamponade, effusion, not responding to NSAID)

Often just analgesia (viral) (ibuprofen, 400mg/8h PO)

consider Colichine (anti uraemia) before steroids

If not viral, treat the cause

care about steroids-can increase risk of recurrence

Question 8

Complications of pericarditis

Answer 8

–Accumulation of transudate, exudate, or blood—-Pericardial effusion w/ or w/o tamponade
fluid in the pericardium-compress heart which causes tamponade (relatively common)
Effusions are common with neoplastic pericarditis and are often recurrent and difficult to manage

rarer-chronic contrictive pericarditis

complications more common for bacterial

Question 9

Prognosis of pericarditis

Answer 9

Prognosis generally depends on the underlying cause and disease severity.

big ones-effusion and tamponade
high fevers
not respond to NSAID

trauma, immunosupresion

usually self limited in 70%/90% of patients

complications more common for bacterial