Acute Pericarditis

Question 1

What are the causes of acute pericarditis?

Answer 1

It may be idiopathic or secondary to:

• Viruses (coxsackie, influenza, EBV, mumps, varicella, HIV)
• Bacteria (pneumonia, rheumatic fever, TB, staph, strep, mycobacterium avium intracellulare in HIV)
• Fungi
• MI (Dressler’s syndrome)
• Drugs (procainamide, hydralazine, penicillin, cromolyn sodium, isoniazid
• Others (uraemia, RA, SLE, myxoedema, trauma, surgery, malignancy (and antineoplastic agents, radiotherapy, sarcoidosis)

Question 2

What are the clinical features of acute pericarditis?

Answer 2

Central chest pain which is worse on inspiration or lying flat and which may be relieved by leaning forward. A pericardial rub may be heard and signs of pericardial effusion and cardiac tamponade may be seen. Fever is sometimes present.

Question 3

Which investigations would you order for a patient with suspected acute pericarditis?

Answer 3

ECG, bloods, CXR and echo (if a pericardial effusion is suspected).

Question 4

What are the ECG findings for someone with acute pericarditis?

Answer 4

Concave (saddle-shaped) ST elevation. It can be normal or non-specific.

Question 5

What blood tests would you order for a patient with suspected acute pericarditis?

Answer 5

FBC, ESR, urea and electrolytes, cardiac enzymes (NB troponin may be raised), viral serology, blood cultures.

If indicated, fungal precipitins and thyroid function tests may be added.

Question 6

What are you likely to find on a CXR in someone with acute pericarditis and what is the significance of this?

Answer 6

Cardiomegaly which may be a sign of pericardial effusion.

Question 7

How would you treat a patient with pericardial effusion?

Answer 7

Analgesia e.g. Ibuprofen, treat the cause and consider colchicine before steroids or immunosuppressants in relapse or persistent symptoms.

Question 8

What is acute pericarditis?

Answer 8

Inflammation of the pericardium.