Acute and Chronic Pericarditis

Question 1

Aetiology and pathophysiology of Pericarditis

Answer 1

-Idiopathic
-Infection (acute viral, TB, bacterial pneumonia)
-Post-myocardial infarction
-Iatrogenic (pacemaker, PCI)
-Autoimmune (systemic sclerosis, lupus)
-Neoplastic (metastatic from breast cancer, lung cancer, lymphoma)
-Metabolic (uraemia, anorexia, myxoedema)

Question 2

Symptoms of pericarditis

Answer 2

-Sharp central chest pain
=Accentuated lying supine, relieved sitting upright
=Exacerbated by deep inspiration or coughing
-May be accompanied by fever, palpitation, dyspnoea
-Other symptoms consistent with aetiology (rheumatic in connective tissue disease)

Question 3

Clinical signs of pericarditis

Answer 3

-Fever
-Pericardial rub (biphasic scratching sound, systole, lying supine)
-Pulsus paradoxus
-Beck’s triad -tamponade: muffled heart sounds, hypotension, elevated JVP

Question 4

Investigations of pericarditis

Answer 4

-ECG: PR depression, widespread concave ST elevation, T wave changes
-Blood panel: FBC, UEs, CRP/ESR (inflammatory, metabolic disturbance), troponin (myocarditis)
-CXR (pericardial effusion)
-Consider echocardiogram
-Consider CT/MRI in refractory pericarditis

Question 5

Treatment of pericarditis

Answer 5

-NSAIDs
-Colchicine (consider prolonged course)
-Exercise restriction
-Corticosteroids (autoimmune, relapsing)
-Pericardiocentesis (tamponade, neoplastic or infective aetiology)
-Treatment directed toward aetiology

Question 6

Prognosis and long-term care of pericarditis

Answer 6

-Serious complications rare (e.g., tamponade)
-Recurrent pericarditis in 1 in 4
-Chronic recurrent pattern rare
-Constrictive pericarditis rare (most often in suppurative pericarditis)