Pericarditits

Question 1

Pericarditits: Definition

Answer 1

• Pericarditis is an inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4-6 weeks.
• It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate.
• It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes.
• Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis.
• Pericarditis is the most common disease of the pericardium encountered in clinical practice.

Question 2

Pericarditits: Aetiology

Answer 2

• As many as 90% of acute pericarditis cases are either idiopathic or due to viral infections
  
  • mumps
  • EBV
  • cytomegalovirus
  • varicella
  • rubella
  • HIV
• Systemic autoimmune disorders are also a common cause
  
  • (e.g., rheumatoid arthritis/ IBS)
• Fungal and drug causes are rare.
• Post MI

Question 3

Pericarditits: Risk factors

Answer 3

• male sex
• age 20 to 50 years
• transmural MI
• cardiac surgery

Question 4

Pericarditis: Pathophysiology

Answer 4

• All signs and symptoms of acute pericarditis result from inflammation of the pericardial tissue.
• The pericardium is well-innervated and inflammation causes severe pain.
• I’m assuiming the pathophysiology is just that of virus derived inflammation (if caused by viruses)

Question 5

Pericarditits: Cinical manifestations: key presentations, other symptoms and signs

Answer 5

• Classic sign: pericardial friction rub (sounds like crunching snow)
  
  • ‘A monophasic, biphasic, or triphasic pericardial friction rub is pathognomonic of acute pericarditis with virtually 100% specificity.’
• may present with progressive, severe, retrosternal chest pain that is sharp and pleuritic in nature

Question 6

Pericarditits: Investigations (diagnosis): 1st line, gold standard & other

Answer 6

ECG

• Relatively subtle difference to a STEMI
• Diffuse ST segment elevation, concave ST segment
• No reciprocal ST depression (except in AVR and V1)
• Saddle shaped
• PR depression
• Mechanism is due to epicardial inflammation

Troponin

• Not particularly specific or sensitive
• Mildly elevated
• Elevation may suggest myopericarditis

Bloods

• ESR and CRP may be elevated
• White count may be high

CXR

• Normally normal unless pericardial effusion is very large, may help is lung problem thought to be related

Echocardiogram

• Useful in pericardial effusion
• P​**ic: ECG in a patient with acute pericarditis, showing diffuse ST-segment elevation in the precordial leads. There is also PR-segment depression in leads V2-V6 (arrows)*

Question 7

Pericarditis: DDx

Answer 7

• Myocardial infarction or ischaemia
• Pulmonary embolism
• Pneumonia

Question 8

Pericarditis: Management

Answer 8

• Treatment is directed at any identified underlying disorder with supportive management directed at relief of symptoms.
• Hospitalisation is generally recommended to determine aetiology, observe for complications such as cardiac tamponade, and gauge response to therapy.
• Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis with gastroprotection.
• Serum CRP should be considered to guide the treatment length and assess the response to therapy.