Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium
Acute: Fibrinous, Purulent, Caseous (TB)
Chronic: Constrictive, Effusive-constrictive

Question 2

List 5 symptoms of pericarditis

Answer 2

Sharp, severe retrosternal chest pain worse with inspiration + when lying flat
Dyspnoea
Non-productive cough
Nausea
Myalgia

Question 3

What are 8 causes of pericarditis?

Answer 3

IDIOPATHIC
Infective
Connective tissue disease (e.g. RhA, SLE)
Post-MI (< 24-72h= fibrinous)
Dressler’s Syndrome: AI pericarditis weeks/ months after acute MI
Malignancy: lung, breast, lymphoma, leukaemia
Radiotherapy
Uraemia

Question 4

What are 5 common causative organisms in infective pericarditis?

Answer 4

Coxsackie B  
Mumps  
Streptococci 
Staphylococci 
TB

Question 5

List 3 signs of pericarditis

Answer 5

Fever
Pericardial friction rub (Heard best at lower LSB, with pt leaning forward during expiration)
HS may be faint due to a pericardial effusion

Question 6

List 3 signs of cardiac tamponade

Answer 6

Beck’s Triad (signs a/w acute cardiac tamponade)
Tachycardia
Pulsus paradoxus

Question 7

What is Beck’s triad?

Answer 7

Raised JVP
Low BP
Muffled Heart Sounds

Question 8

What is cardiac tamponade?

Answer 8

Accumulation of blood, fluid, pus, clots, or gas in the pericardial space, resulting in reduced ventricular filling

Question 9

List 5 risk factors for pericarditis

Answer 9

Male sex
Age 20- 50
Transmural MI
Cardiac surgery
Viral/ bacterial infection

Question 10

What is pulses paradoxus?

Answer 10

Abnormally large decrease in SBP (> 10 mmHg) + pulse wave amplitude during inspiration

Question 11

What is seen on ECG in pericarditis?

Answer 11

Widespread concave “saddle shaped” ST elevation + PR depression (I, II, III, aVF, V4-6)
Reciprocal ST depression + PR elevation in V1 + aVR

Question 12

What is the most specific ECG marker for pericarditis?

Answer 12

PR depression

Question 13

What blood investigations are appropriate for pericarditis?

Answer 13

FBC: ?high WCC
U+Es: ?high urea if uraemic cause
ESR/ CRP: high
Serum troponin (normal/ elevated) 
Blood cultures

Question 14

What is seen on CXR in pericarditis?

Answer 14

Usually normal
If large pericardial effusion, cardiothoracic ratio increases

Question 15

What imaging must all patients with suspected pericarditis have?

Answer 15

Transthoracic echocardiogram

Question 16

What is the acute management plan for pericarditis if in cardiac tamponade, purulent/ neoplastic pericarditis or symptomatic effusion?

Answer 16

Emergency pericardiocentesis

Question 17

Describe management setting for pericarditis

Answer 17

Majority: outpatient
High risk features (>38, high trops): inpatient

Question 18

What is the medical management plan for pericarditis?

Answer 18

Treat underlying cause  
NSAIDs (pain + fever relief) + PPI (gastric protection)
COLCHICINE
Exercise restriction
\+ anti-virals if appropriate

Question 19

What is the 2nd and 3rd line medical management plan for recurrent pericarditis? (1st line is as medical management)

Answer 19

2: Low-dose corticosteroid
3: Immunosuppressant e.g. Azathioprine

Question 20

What is the surgical management for persistent symptomatic recurrent pericarditis?

Answer 20

Pericardiectomy

Question 21

List 3 complications of pericarditis

Answer 21

Pericardial effusion
Cardiac tamponade
Chronic constrictive pericarditis

Question 22

What is the prognosis in pericarditis?

Answer 22

Self-limiting disease without significant complications/ recurrences in 70-90%=

Question 23

What is important about the age group that this cause of chest pain can present in?

Answer 23

May present in the YOUNG