Pericarditis

Question 1

Define pericarditis.

Answer 1

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.

Question 2

Explain the aetiology/risk factors of pericarditis.

Answer 2

Having cardiac surgery or being on dialysis can also increase the risk of getting pericarditis. Viral or bacterial infections can also cause this.

Question 3

Summarise the epidemiology of pericarditis.

Answer 3

Acute pericarditis is more common in adults (typically between 20 to 50 years old) and in men. It is the most common disease of the pericardium encountered in clinical practice. The true incidence and prevalence of the disease are unknown and there are a large number of undiagnosed cases.

Question 4

Recognise the presenting symptoms of pericarditis.

Answer 4

Chest pain
Pericardial friction rub
Fever

Question 5

Recognise the signs of pericarditis on physical examination.

Answer 5

Symptoms and signs of right-sided heart failure, including fatigue, ankle oedema, and, in severe cases, ascites.

Question 6

Identify appropriate investigations for pericarditis and interpret the results.

Answer 6

ECG
Echocardiogram
CXR
Serum urea
FBC
Blood culture
Troponin

Question 7

Generate a management plan for pericarditis.

Answer 7

Pericardiocentesis + systemic antibiotics
Non-steroidal anti-inflammatory drug (NSAID)
Proton-pump inhibitor
Exercise restriction

Second line treatment is a pericardiectomy.

Question 8

Identify the possible complications of pericarditis and its management.

Answer 8

Pericardial effusion with or without cardiac tamponade
Chronic constrictive pericarditis

Question 9

Summarise the prognosis for patients with pericarditis.

Answer 9

Prognosis generally depends on the underlying cause and disease severity. Features associated with a poor prognosis include:
Evidence of a large pericardial effusion (i.e., diastolic echo-free space >20 mm)
High fever (i.e., >38°C)
Sub-acute course (i.e., symptoms over several days without a clear-cut acute onset)
Failure to respond within 7 days to a non-steroidal anti-inflammatory drug (NSAID).