Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of pericardium

Question 2

What are the causes of pericarditis? (7)

Answer 2

• Idiopathic (no underlying cause)
• Infection (e.g., tuberculosis, HIV, coxsackievirus, Epstein–Barr virus and other viruses)
• Autoimmune and inflammatory conditions (e.g., systemic lupus erythematosus and rheumatoid arthritis)
• Injury to the pericardium (e.g., after myocardial infarction, open heart surgery or trauma)
• Uraemia (raised urea) secondary to renal impairment
• Cancer
• Medications (e.g., methotrexate)

Question 3

What are the main viral causes of pericarditis?

Answer 3

Tuberculosis
HIV
Coxsackievirus
EBV

Question 4

What is pericardial effusion?

Answer 4

when the potential space of the pericardial cavity fills with fluid.
○ This creates an inward pressure on the heart, making it more difficult to expand during diastole (filling of the heart).

Question 5

What is pericardial tamponade?

Answer 5

where the pericardial effusion is large enough to raise the intra-pericardial pressure.
○ This increased pressure squeezes the heart and affects its ability to function.
○ It reduces heart filling during diastole, decreasing cardiac output during systole.
○ This is an emergency and requires prompt drainage of the pericardial effusion to relieve the pressure.

Question 6

What are the 2 key features of pericarditis?

Answer 6

Chest pain
Low grade fever

Question 7

What is the chest pain like in pericarditis? (5)

Answer 7

• Sharp
• Central/anterior
• Worse with inspiration (pleuritic)
• Worse on lying down
• Better on sitting forward

Question 8

What is a key clinical sign that can be found in pericarditis?

Answer 8

Pericardial friction rub on auscultation is a key examination finding. A pericardial rub is a rubbing, scratching sound that occurs alongside the heart sounds.

Question 9

What 3 investigations are done in pericarditis and what do they show?

Answer 9

Bloods - raised inflammatory markers
ECG = saddle shaped ST elevation, PR depression
Echo - diagnoses pericardial effusion

Question 10

What are the key ecg findings in pericarditis?

Answer 10

Saddle shaped ST elevation
PR depression

Question 11

What is the medical management of pericarditis? (2)

Answer 11

NSAIDs
Colchicine (taken longer-term, e.g., 3 months, to reduce the risk of recurrence)

Question 12

What is the second line medical management in pericarditis?

Answer 12

Steroids may be used second-line, in recurrent cases or associated with inflammatory conditions (e.g., rheumatoid arthritis)

Question 13

What is pericardiocentesis?

Answer 13

Pericardiocentesis may be required to remove fluid from around the heart if there is a significant pericardial effusion or tamponade.