Pericarditis

Question 1

you are working on the Coronary Care Unit as a JHO. The Casualty Officer tells you that a patient, Mr PC, a 35 year old man, has developed signs and symptoms of pericarditis. His arrest page goes off and he is called away and he asks you to sort the patient out.

Answer 1

-

Question 2

a) List 4 features which would help you confirm the pain is pericardial in origin?

Answer 2

• site: retrosternal / over left precordium
• onset: not related to exertion
• character: sharp / stabbing / aching (not constricting like MI/angina)
• radiation: left shoulder
• E+R factors: relieved on sitting up or bending forward, worse when lying flat

Question 3

b) List 2 signs you would expect to find in Mr PC’s case?

Answer 3

• pericardial rub
• fever
• tachypnoea
• tachycardia

Question 4

c) The ward sister suggests you do an ECG. List 1 abnormality you would
expect to see if the patient has pericarditis?

Answer 4

• concave upwards STe (“saddle shaped”)

- PR depression

Question 5

d) What would be the first-line treatment of choice?

Answer 5

NSAIDs e.g. ibuprofen

Question 6

e) Give 2 side-effects that you would warn him about because they may cause him symptoms?

Answer 6

• GI disturbances (nausea, diarrhoea)
• asthma exacerbation (bronchospasm causing wheeze)
• dyspepsia (bleeding/ulceration)

Question 7

f) The FY2 returns from his arrest and asks you that other causes of pericarditis there are apart from viral disease?

Answer 7

• neoplasm
• idiopathic
• MI
• other infective: e.g. bacteria (TB)
• autoimmune e.g. RA, SLE
• metabolic disorders e.g. uraemia
• iatrogenic e.g. radiotherapy, cardiac surgery, PCI
• Dressler’s syndrome