Acute Pericarditis

Question 1

causes of acute pericarditis

Answer 1

-traumatic
-Drug induced
- Infectious Most Common Viral
=coxsackie B virus
or idiopathic ..
-Neoplastic
-Immune/inflammatory
-Metabolic
- Iatrogenic

Question 2

Symptoms

Answer 2

• Chest pain (can be severe)
• dyspnea (common)
• cough, dysphagia, and hiccups
  *❑85% of patients have an audible friction rub

Question 3

Chest pain characteristics in pericarditis

Answer 3

✓Sudden onset, sharp, and worse with inspiration, cough, and body movements
✓
Pain is typically substernal or localized to left chest

✓May be persistent or wax and wane
❑
✓Classically, pain is positional in nature—worse when patient is supine and relieved with sitting up and leaning forward

Question 4

friction rub sound characteristics

Answer 4

-High-pitched scratchy or squeaky sound best
-heard at the left lower sternal border
at end-expiration with the patient leaning forward
-not affected by breathing

Question 5

on ECG

Answer 5

diffuse ST elevation (in all leads
-widespread PR depression
-after several days ST normalize then T wave inversion
-after weeks to months ECG returns normal

Question 6

on Chest radiography

Answer 6

-Often
normal
in patients
-Pulmonary vascular congestion
(may indicate severe
concomitant myocarditis and heart failure)

Question 7

on Echocardiography:

Answer 7

-May see effusions

Question 8

Laboratory studies:

Answer 8

Nonspecific markers of inflammation (leukocytosis,CRP,ESR)

Cardiac enzymes:
May be elevated in patients with
concomitant adjacent myocardial inflammation

Question 9

diagnosis

Answer 9

based on combination of characteristic chest pain ,ECG findings,friction rub,and/or pericardial effusion

Question 10

first line treatment

Answer 10

colchicine or NSAIDs or high dose aspirin

aspirin : 2-4 days (high dose )(300-600 mg/day)
NSAIDS: 600-800 mg 3 times per day
for 1-2 weeks
colchicine : 0.5 mg BID for 3 months

Question 11

purpose of colchicine

Answer 11

*reduce recurrence rate
*enhance response to NSAIDs

Question 12

colchicine side effect

Answer 12

GI upset

Question 13

avoid in pericarditis

Answer 13

*anticoagulants : increase risk for pericardial bleeding and tamponade
*steroids : increase risk of relapse

Question 14

when can we use steroids

Answer 14

only if NSAIDS /aspirin are contraindicated or refractory
**they are second line
** azathioprine/anakinra
**used only for 2-4 days

Question 15

post cardiac injury syndrome

Answer 15

is a form of pericarditis that is caused due to injury to the myocardium ,treatment like pericarditis