Pericarditis (Complete)

Question 1

What is acute pericarditis?

Answer 1

Inflammation of the pericardium

Question 2

Pericardial inflammation which spreads to the myocardium is known as?

Answer 2

Myopericarditis

Question 3

What are the main causes of pericarditis?

Answer 3

Infection

Malignancy

Cardiac:
Heart failure
Post-cardiac injury syndrome

Radiation

Drugs and toxins

Rheumatological diseases

Renal failure (Ureamic pericarditis)

Hypothyroidism (Pericardial effusion)

IBD (due to drug therapy)

Ovarian hyperstimulation

Behcets disease (inflammatory disorder with genital and mouth ulcers, erythema nodosum, vasculitis)

Question 4

List examples of infectious causes of pericarditis

Answer 4

Viruses:
Coxsackie
HIV
Echovirus
CMV (Cytomegalovirus)
Herpesvirus

Bacterial
Staphylococcus
Pneumococcus
Streptococcus
Hameophilus
Mycobacterium tuberculosis

Fungi and parasites (Rare)

Question 5

What type of cancers most commonly cause pericarditis?

Answer 5

Lung cancer

Breast cancer

Hodgkin lymphoma

Question 6

List examples of drugs/toxins which can cause pericarditis

Answer 6

Doxorubicin (Chemo for leukaemia)

Hydralazine (Vasodilator)

Isoniazid (TB AB)

Methyldopa (Antihypertensive)

Phenytoin (Anti-epileptic for tonic-clonic seizures)

Penicillins (Hypersensitivity)

Question 7

List examples of rheumatological diseases which can cause pericarditis

Answer 7

Rheumatoid arthritis

Sarcoidosis

SLE

Vasculitides (E.g. Bechet’s, Takayasu’s)

Question 8

What are the main clinical features of pericarditis?

Answer 8

Chest pain: Pleuritic and worse when lying flat (better when leaning forwards)

Fever

Pericardial friction rub

Other:

Non-productive cough

Dyspnoea

Flu-like symptoms

Question 9

What are the main characteristics of chest pain in pericarditis?

Answer 9

Pleuritic

Worse when lying flat

Better when leaning forward

Question 10

What investigations should be ordered in patients suspected of pericarditis?

Answer 10

Bedside
ECG: Widespread ST saddle-shaped elevation and PR deppresion

Bloods:
FBC: Raised
ESR/CRP: Raised
Troponin: Raised in 30% and indicates possible myopericarditis

Imaging:
Transthoracic echocardiogram
Angiogram: To exclude MI
CXR: Pericardial calcification

Question 11

How does troponin elevation in pericarditis differ to MI?

Answer 11

Tends not to peak like MI and remains consistently elevated during the acute phase.

Question 12

What findings on ECG are suggestive of pericarditis?

Answer 12

Widespread ST elevation

Saddle-shaped ST elevation

PR deppresion: Most specific for pericarditis

Question 13

What investigation is diagnostic for pericarditis?

Answer 13

Transthoracic echocardiogram

Question 14

What is the management plan for a patient with pericarditis?

Answer 14

TREAT UNDERLYING CAUSE

Conservative:
Exercise restriction: Until symptoms and inflammatory markers return to normal

Medicine:
Ibuprofen [NSAIDs but ibuprofen pref] + colchicine: For idiopathic and

IV ABs: if bacterial cause
Corticosteroids: 2nd line to NSAIDs and only if patient has non-viral pericarditis.

Surgical/invasive:
Pericardiocentesis: If purulent exudate or cardiac tamponade.
Pericardectomy: If adhesions or reccurent tamponade occurs

Question 15

Pericarditis is typically managed as outpatient. When would patients be treated as inpatient?

Answer 15

High risk features such as:

> 38 degrees fever

Elevated troponin

Question 16

How is viral pericarditis managed?

Answer 16

NSAIDs + Colchicine

Question 17

Colchicine should be avoided in which groups of patients?

Answer 17

Renal impairement

Hepatic impairment

Question 18

How is bacterial pericarditis managed?

Answer 18

IV ABs

Pericardiocentesis if purulent exudate present

Question 19

Corticosteroids in 2nd line management of pericarditis should be avoid in which types of pericarditis and why?

Answer 19

Viral pericarditis

Due to risk of reactivation

Question 20

What are complications of pericarditis?

Answer 20

Pericardial effusion

Cardiac tamponade

Constrictive pericarditis (Chronic complication)

Question 21

What is constrictive pericarditis?

Answer 21

Scarring and loss of elasticity of the pericardial sac due to pericarditis.

N.B. Results in HF due to reduced filling

Question 22

Constrictive pericarditis tends to develop due to which type of pericarditis?

Answer 22

TB pericarditis

Question 23

What are the main signs/symptoms of constrictive pericarditis?

Answer 23

Signs of fluid overload

Exertional dyspnoea

Raised JVP

Kussmaul’s sign (Rise in JVP during inspiration)

Quiet heart sounds (If pericardial effusion present)

Third heart sound (S3): Due to rapid early diastolic filling

Question 24

What are the key differences between cardiac tamponade and constrictive pericarditis

Answer 24

Question 25

What findings on CXR are indicative of constrictive pericarditis?

Answer 25

Pericardial calcification

Question 26

What ECG finding is most specific for pericarditis?

Answer 26

PR deppresion