[9] Acute Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the sac surrounding the heart

Question 2

What is acute pericarditis?

Answer 2

A type of pericarditis usually lasting less than 6 weeks

Question 3

What are the causes of pericarditis?

Answer 3

• Idiopathic
• Viruses
• Bacteria
• Fungi
• Parasites
• Autoimmune system
• Drugs
• Metabolic abnormalities
• Trauma
• Surgery
• Malignancy
• Radiotherapy
• MI
• Chronic heart failure

Question 4

What are the viral causes of pericarditis?

Answer 4

• Coxsackie
• Echovirus
• EBV
• CMV
• Adenovirus
• Mumps
• Varicella
• HIV

Question 5

What are the bacterial causes of pericarditis?

Answer 5

• TB
• Lyme disease
• Q fever
• Pneumonia
• Rheumatic fever
• Staphs
• Streps
• Mycoplasma
• Legionella

Question 6

What are the autoimmune causes of pericarditis?

Answer 6

• SLE
• RA
• Vasculitides
• IBD
• Sarcoidosis
• Amyloidosis
• Dressler’s

Question 7

What drugs can cause pericarditis?

Answer 7

• Procainamide
• Hydralazine
• Penicillin
• Isoniazid
• Chemotherapy

Question 8

What are the metabolic causes of pericarditis?

Answer 8

• Anorexia nervosa
• Hypothyroidism
• Uraemia

Question 9

What are the signs and symptoms of pericarditis?

Answer 9

• Central chest pain, worse on inspiration or lying flat
• Fever
• Pericardial friction rub
• Evidence of pericardial effusion or tamponade

Question 10

What investigations are involved in the diagnosis of pericarditis?

Answer 10

• ECG
• Blood tests
• Chest x-ray
• Echo if suspected pericardial effusion

Question 11

What does the ECG show in pericarditis?

Answer 11

Classically shows concave (saddle-shaped) ST segment elevation and PR depresion, but may be normal or non-specific

Question 12

Which pericarditis patients can be managed in an outpatient setting, without the need for hospital

Answer 12

Stable patients

Question 13

What is involvement in the outpatient management of pericarditis?

Answer 13

• Treatment of underlying cause
• Rest, and avoidance of any demanding physical activity
• NSAIDs
• Colchine

Question 14

What NSAIDs are given first line in the outpatient management of pericarditis?

Answer 14

Naproxen 250mg 6-8 hourly

Question 15

How long should NSAIDs be given in the outpatient management of pericarditis?

Answer 15

7-14 days, and then the dose should be tapered until resolution of symptoms and improvement in CRP and ESR readings

Question 16

What is the advantage of using colchine in outpatient management of pericarditis?

Answer 16

• It has been shown to result in significantly fewer recurrences and long symptom free periods
• When attacks occur, they are weaker and shorter in nature

Question 17

When is admission to hospital inidicated in pericarditis?

Answer 17

• Evidence suggesting a cardiac tamponade
• A large pericardial effusion
• Immunosuppressed state
• Patients on warfarin
• Acute trauma
• Failure to respond within 7 days to NSAIDs