Pericarditis

Question 1

Define pericarditis

Answer 1

Pericarditis = inflammation of the pericardium (fibrous and serous) that surrounds the heart

Question 2

Describe the epidemiology of pericarditis

Answer 2

• More common in adults than in children
• In UK pericarditis is most commonly secondary to viral infection or MI
• Occurs more in men

Question 3

Describe the aetiology of pericarditis

Answer 3

1. ) Viral infection: HIV/Coxsackie B virus/echovirus
2. ) Bacterial infection: TB or fungal: histoplasma spp
3. ) Autoimmune: e.g. Sjogren’s syndrome or SLE
4. ) Previous MI that has led to Dressler’s syndrome
5. ) Uraemia
6. ) Malignancy: breast/lung
7. ) Idiopathic

Question 4

Describe the risk factors for pericarditis

Answer 4

• Previous MI

- Having an autoimmune condition

Question 5

Describe the types of pericarditis

Answer 5

1. ) Acute pericarditis

2. ) Constrictive pericarditis

Question 6

What is the pathophysiology of pericarditis

Answer 6

General overview: pericardium becomes inflamed, with pericardial vascularisation + infiltration ith polymorphonuclear leukocytes. A fibrinous reaction results in exudate and adhesions within the sac

• Acute: inflammation of pericardium causes serous pericardium to produce more fluid that can lead to a pleural effusion and tamponade, where fluid pools around the heart, preventing the heart from fully contracting
• Constrictive: inflammation of pericardium causes serous pericardium to secrete a thicker fluid that contains lots of fibrin. Causes the pericardium to become thicker, and this means that the heart is constricted and can’t fully contract

Question 7

Describe the clinical presentations (signs) of pericarditis

Answer 7

• Pericardial friction rub heard by auscultation
• Chest pain worse on inspiration
• Raised JVP

Question 8

What are the symptoms of pericarditis

Answer 8

• Chest pain: sudden and sharp
• Dyspnoea
• Hiccups
• Fever

Question 9

Describe the investigations and a differential diagnosis for pericarditis

Answer 9

1. ) ECG:
   - Acute pericarditis: show ST elevation and PR depression, then loss of T wave, then inverted T wave, then normal
   - Constrictive/pleural effusion: lower QRS due to lower voltage
2. ) Bloods: WBC count will be increased/cardiac enzymes/C-reactive protein
3. ) Troponin levels: could be higher
4. ) Echocardiogram

Question 10

Describe the management and treatment options

Answer 10

1. ) NSAIDS
2. ) Colchicine (stops migration of neutrophils to site of inflammation
3. ) Pericardiocentesis (drainage of fluid if cardiac tamponade)

Question 11

Describe the complications of pericarditis

Answer 11

1. ) Pericardial effusion
2. ) Cardiac tamponade
3. ) Chronic constrictive pericarditis