Pericarditis

Question 1

What is pericarditis?

Answer 1

Inflammation of the pericardium with or without effusion

Question 2

What group of people is pericarditis most commonly seen in?

Answer 2

Men aged 20-50

Question 3

What may the effusion be in pericarditis?

Answer 3

Exudative (if due to infection or malignancy)

Blood (if due to haemorrhage)

Question 4

What are causes of pericarditis?

Answer 4

May be idiopathic
Virus eg. coxsackie virus
Bacterial eg. TB
Fungal (v rare) eg. histoplasmosis in immunocompromised patients
Autoimmune eg SLE, Sjorgen’s, RA
Dressler’s syndrome
Neoplastic

Question 5

In pericarditis, inflamed pericardial layers rub against each other and exacerbates further _____

Answer 5

Inflammation

Question 6

What are symptoms of pericarditis?

Answer 6

Sharp pleuritic chest pain with referral to left shoulder tip/trapezius ridge (phrenic nerve)

Pain relieved by sitting forward
Worse lying flat of on inspiration (pleuritic pain)

Question 7

What is auscultated with pericarditis?

Answer 7

Pericardial friction rub
Heard when patient leans forwards
Squeaky leather “to and fro” sound

Question 8

How is pericarditis diagnosed?

Answer 8

ECG diagnostic criteria:
Widespread saddle shaped ST elevation
PR depression

CXR: may show “water bottle” heart (large pericardial effusion)
Pneumonia commonly seen (bacterial eg TB)

ESR: Raised, seen in autoimmune, raised WCC if infective

Question 9

How is pericarditis treated?

Answer 9

If idiopathic or viral:
NSAIDs for 2 weeks (eg aspirin)
and Colchicine (anti-inflammatory) for 3 weeks

If bacterial:
Antibiotics

Question 10

How is TB treated?

Answer 10

“RIPE”
Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Question 11

What is a differential diagnosis to pericarditis?

Answer 11

MI
Also present with central crushing chest pain
However, not related to lying down and no pericardial rub

Question 12

What is constrictive pericarditis?

Answer 12

Thickening and fibrosis of pericardium. Loses ability to stretch so impaired filling of heart chambers during diastole.
Leads to decreased cardiac output.

Question 13

What are complications of pericarditis?

Answer 13

Constrictive pericarditis
Pericardial effusion causing cardiac tamponade
Myocarditis

Question 14

What causes constrictive pericarditis?

Answer 14

Idiopathic
Prior pericarditis (inflammation leads to fibrosis)
Cardiac surgery
Radiation therapy
Infections

Question 15

What are signs of constrictive pericarditis?

Answer 15

Dyspnoea
Peripheral oedema
Ascites
Fatigue
Elevated JVP
Kussmaul’s sign (rise in JVP during inspiration due to impaired filling)

Question 16

May have sign of ____ hand side heart failure with constrictive pericarditis as granulation tissue forms in pericardium means impaired diastolic filling

Answer 16

Right

Will have SOB, peripheral oedema and tachycardia

Question 17

What is cardiac tamponade?

Answer 17

Accumulation of fluid in the pericardial sac, increasing pressure on the heart and impairing diastolic filling. Causes decreased cardiac output and potentially fatal circulatory collapse so is a life-threatening condition.

Question 18

What can cause cardiac tamponade?

Answer 18

Trauma eg stabbing
Pericarditis
iatrogenic causes eg cardiac catheterisation
Aortic aneurysm rupture