pericarditis

Question 1

definition of pericarditis

Answer 1

Inflammation of the pericardium, may be acute, subacute or chronic.

Question 2

aetiology of pericarditis

Answer 2

idiopathic

infective

connective tissue disease - sarcoid, SLE, scleroderma, rheymatoid arthritis, IBD, amyloid, vasculitides eg Behçet, Takayasu

post-MI (24-72hrs) in up to 20% patients

dressler’s syndrome - weeks to months after MI

malignancy - lung, breast, lymphoma, leukaemia, melanoma

metabolic (myxoedema, uraemia, anorexia nervosa)

radiotherapy

thoracic surgery

trauma

chronic HF

drugs - hydralazine, isoniazid, procainamide, penicillin, chemo

Question 3

infective causes of pericarditis

Answer 3

• coxsackie B virus
• echovirus
• mumps virus
• EBV
• adenovirus
• varicella virus
• HIV
• MAI in HIV
• streptococci
• fungi - leginonella
• mycoplasma
• staphylococci
• TB
• Lyme disease
• Q fever
• pneumonia
• rheumatic fever

Question 4

epidemiology of pericarditis

Answer 4

uncommon

clinical incidence <1/100 admissions

males

Question 5

sx of pericarditis

Answer 5

chest pain

• sharp and central
• radiate to neck/shoulders
• aggravated by coughing, deep inspiration or lying flat
• relieved by sitting forward

dyspnoea

nausea

Question 6

signs of pericarditis

Answer 6

fever

pericardial friction rub - best heard over lower L sternal edge, with pt leaning forward in expiration

heart sounds faint in the presence of effusion

cardiac tamponade

constrictive pericarditis (chronic)

Question 7

signs of cardiac tamponade

Answer 7

raised JVP, reduced BP and muffled heart sounds - Beck’s triad

tachycardia

pulsus paradoxus - reduced SBP by >10mmHg on inspiration

Question 8

signs of constrictive pericarditis

Answer 8

raised JVP with inspiration (Kussmaul’s sign)

pulsus paradoxus

hepatomegaly

ascites

oedema

pericardial knock - rapid ventricular filling

AF

Question 9

Ix for pericarditis

Answer 9

ecg

echo

bloods

CXR

CMR and CT - localised inflammation

Question 10

ecg for pericarditis

Answer 10

wide saddle shaped ST elevation (concave)

PR depression

Question 11

echo for pericarditis

Answer 11

assessment of pericardial effusion and cardiac func

Question 12

blood for pericarditis

Answer 12

FBC, UE, ESR, CRP, cardiac enzymes (usually normal)

blood cultures

ASO titres

ANA

rheumatic factor

TFT

mantoux test

viral serology

Question 13

cxr for pericarditis

Answer 13

usually normal

(globular heart shadow if>250mL effusion).

Pericardial calcification can be seen in constrictive pericarditis (best seen on lateral CXR or CT).

Question 14

Mx for pericarditis

Answer 14

acute - cardiac tamponade treated by emergency pericardiocentesis

medical

• treat cause
• NSAIDs for relief of pain/fever with gastric protection

recurrent - low dose steroids, immunosuppressants or colchicine

surgical - Surgical excision of the pericardium (pericardiectomy) in constrictive pericarditis.

Question 15

complications of pericarditis

Answer 15

Pericardial effusion, cardiac tamponade, cardiac arrythmias.

Question 16

Px of pericarditis

Answer 16

Depends on underlying cause.

Good prognosis in viral cases (recovery within 2 weeks),

poor in malignant pericarditis.

Pericarditis may be recurrent (particularly in thosecaused by thoracic surgery).