MYOPERICARDIAL SYNDROMES Flashcards
MANAGEMENT
INVESTIGATION
CBC
INR
Lytes
Urea
Cr
CRP
Trop
TSH
SERIAL ECG
CXR (if signs of CHF)
Echo - Effusion, cardiac function, r/o tamponade
FIRST LINE TREATMENT: UNCOMPLICATED
Ibuprofen 600-800 mg PO q 6-8 h
OR
ASA 2-4 g/day in divided doses
WITH
Colchicine 0.5 mg bid (if >70 kg) x 3 months
0.5 mg od (if <70 kg) x 3 months
SECOND LINE TREATMENT OR C/I TO FIRST LINE
Prednisone: 0.25–0.50 mg/kg/day
>50 mg Taper 10 mg/day every 1–2 weeks
50–25 mg Taper 5–10 mg/day every 1–2 weeks
25–15 mg Taper 2.5 mg/day every 2–4 weeks
<15 mg Taper 1.25–2.5 mg/day
MONITOR
Dilated Cardiomyopathy
Congestive Heart Failre
DISPOSITION: ADMISSION CRITERIA
Major
* Fever >38°C
* Subacute onset
* Large pericardial effusion
* Cardiac tamponade
* Lack of response to aspirin or NSAIDs
after at least 1 week of therapy
Minor
* Myopericarditis
* Immunosuppression
* Trauma
* Oral anticoagulant therapy
DISPOSITION: LOW RISK
Follow Up in 1 week to reassess response to treatment: CRP
Restrict physical activity beyond ordinary sedentary life until resolution of symptoms and normalization of CRP for patients not involved in competitive
sports
A minimal restriction of 3 months from competitive sports for athletes
DOCUMENTATION
CLINICAL FEATURES
Sudden Onset
Sharp / Pleuritic chest pain
Relieved sitting forward /Aggravated by laying down
Radiating towards the trapezius ridge (virtually pathoognomonic)
Recent URI / Illness
a/w
Low-grade fever
Dyspnea
Cough
Dysphagia
Ewart’s Sign
Intermittent Friction Rub LLSB
Clinical Features of CHF if severe
DIAGNOSTIC CRITERIA
2/4 of:
(1) Pericardial chest pain
(2) Pericardial rubs
(3) new widespread ST-elevation or PR depression on ECG
(4) Pericardial effusion (new or worsening)
Additional support:
-elevated inflammatory markers
-evidence of pericardial inflammation on imaging
ECG
Stage 1 – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks)
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)
Stage 3 – flattened T waves become inverted (3 to several weeks)
Stage 4 – ECG returns to normal (several weeks onwards)
DDX: Pericarditis Etiology
Idiopathic (MC)
Traumatic / Iatrogenic
Drugs (rare)
Infectious
Inflammatory (autoimmune) (common)
Uremic, myxodema
Post myocardial infarction
Neoplasm
