Pericarditis

Question 1

Define pericarditis

Answer 1

Inflammation of the pericardium surrounding the heart

Question 2

Aetiology of pericarditis

Answer 2

Idiopathic 
May be preceded by URTI
Viral: Coxsacki B, echovirus, EBV
Bacterial: TB, Lyme
Autoimmune: SLE, RA, systemic sclerosis
Drugs: procainamide, isoniazid, penicillin
Metabolic: uraemia, hypothyroidism 
Trauma, surgery, malignancy

Question 3

Risk factors for pericarditis

Answer 3

Male 
20-50
Transmural MI 
Cardiac surgery 
Neoplasm 
Viral and bacterial infections 
Uraemia or on dialysis

Question 4

Symptoms of pericarditis

Answer 4

Pleuritic chest pain (central stabbing pain, worse on inspiration, lying flat, coughing, relieved on leaning forward)
Fever
Malaise
Dyspnoea

Question 5

Signs of pericarditis

Answer 5

Pericardial friction rub (high pitched or squeaky rub at the left sternal edge, patient leaning forward, end-expiration)
Signs of RHF: raised JVP, ascites, peripheral oedema

Question 6

Investigations for pericarditis

Answer 6

ECG: Widespread saddle shaped ST elevation | PR depression

ESR/CRP: Raised
FBC: WCC raised if infectious cause
Trops: raised or normal
U+Es: Urea elevated or normal

Pericardial fluid/blood culture: +ve for causative organism

CXR: normal or cardiomegaly
Echo: Normal, check for effusion/tamponade

Question 7

Management for pericarditis

Answer 7

Treat the cause
Colchicine 500mg OD
NSAIDs/aspirin + PPI
Bed rest until symptoms resolve

Question 8

Complications for pericarditis

Answer 8

Pericardial effusion (-> pericardiocentesis)

Constrictive pericarditis (-> surgical excision)

Cardiac tamponaden effusion drainage

Question 9

Prognosis for pericarditis

Answer 9

Usually self-limiting (70-90%)

Purulent pericarditis is fatal if untreated