Pericarditis

Question 1

Define pericarditis

Answer 1

Inflammation of the pericardium

It may be acute, subacute or chronic

Question 2

Summarise the epidemiology of pericarditis

Answer 2

UNCOMMON
< 1/100 hospital admissions
More common in males

Question 3

Explain the aetiology/risk factors of pericarditis

Answer 3

IDIOPATHIC

Infective - Most common causative organisms:
Coxsackie B
Echovirus
Mumps
Streptococci
Fungi
Staphylococci
TB

Connective tissue disease (e.g. sarcoidosis, SLE, scleroderma)

Post-MI (within 24-72 hrs of MI-occurs in up to 20% of patients)

Dressler’s Syndrome- pericarditis occurring weeks/months after acute MI

Malignancy- lung, breast, lymphoma, leukaemia, melanoma

Radiotherapy

Thoracic surgery

Drugs (e.g. hydralazine, isoniazid)

Question 4

Recognise the presenting symptoms of pericarditis

Answer 4

CHEST PAIN
Sharp and central
May radiate to the neck or shoulders
Worse when coughing and deep inspiration (pleuritic pain)
Relieved by sitting forward
Dyspnoea
Nausea

Question 5

Recognise the signs of pericarditis on physical examination

Answer 5

Fever

Pericardial friction rub (Heard best at lower left sternal edge, with patient leaning forward during expiration)
Heart sounds may be faint due to a pericardial effusion

Cardiac Tamponade signs:
Beck’s Triad - Raised JVP, Low Blood Pressure, Muffled Heart Sounds

Tachycardia

Pulsus paradoxus - Definition: an abnormally large
decrease in SBP (> 10 mm Hg drop) and pulse wave amplitude during inspiration

Constrictive Pericarditis signs
Kussmaul's sign
Pulsus paradoxus
Hepatomegaly
Ascites
Oedema
Pericardial knock (due to rapid ventricular filling)
AF

Question 6

Identify appropriate investigations for pericarditis

Answer 6

ECG- widespread saddle-shaped ST elevation

Echocardiogram - assesses pericardial effusion and cardiac function

FBC
U&Es
ESR/CRP
Cardiac Enzymes (usually normal)

Other investigations for cause: blood cultures,
ASO titres, ANA, rheumatoid factor

CXR
Usually normal
May be globular if there is a pericardial
effusion

Question 7

Generate a management plan for pericarditis

Answer 7

Acute- cardiac tamponade is treated with emergency
pericardiocentesis

Medical
Treat underlying cause
NSAIDs for pain and fever relief

Recurrent
Low-dose steroids
Immunosuppressants
Colchicine

Surgical
Pericardiectomy is performed in cases of constrictive pericarditis

Question 8

Identify the possible complications of pericarditis

Answer 8

Pericardial effusion
Cardiac tamponade
Cardiac arrhythmia

Question 9

Summarise the prognosis for patients with pericarditis

Answer 9

Depends on the underlying cause
Viral cases have a GOOD prognosis
Malignant pericarditis has a POOR prognosis