Acute Pericarditis

Question 1

MC sx of acute pericarditis

Answer 1

• acute sharp or stabbing substernal CP
• worse w/ inspiration and when lying flat
• alleviated when sitting and leaning forward

Question 2

possible medical hx may include:

Answer 2

• preceding viral sxs
• cancer (current or past)
• recent trauma
• arthralgia, or arthritis (suggesting systemic rheumatic disease)
• MI
• recent thoracic surgical procedures
• hydralazine, phenytoin, minoxidil

Question 3

characteristic PE finding

Answer 3

2- or 3-component pericardial friction rub

Question 4

PE finding that may be present in pericardial tamponade

Answer 4

pulsus paradoxus 10 mmHg or more

Question 5

typical ECG findings

Answer 5

• DIFFUSE STE w/ upward concave movement (w/o reciprocal STD)
• PR-segment depression in limb leads
• PR-segment elevation in aVR

Question 6

possible ECG finding in pts w/ large pericardial effusions

Answer 6

electrical alternans (alternating high- and low-voltage QRS complexes)

Question 7

test that may show effusion or early tamponade

Answer 7

echocardiogram

Question 8

ECG features differentiating acute pericarditis from MI:

acute pericarditis: ST-segment contour

Answer 8

conCAVE upwards

Question 9

ECG features differentiating acute pericarditis from MI:

acute pericarditis: ST-segment lead involvement

Answer 9

DIFFUSE

Question 10

ECG features differentiating acute pericarditis from MI:

acute pericarditis: reciprocal ST-T changes

Answer 10

NO

Question 11

ECG features differentiating acute pericarditis from MI:

acute pericarditis: PR-segment abnormalities

Answer 11

YES

Question 12

ECG features differentiating acute pericarditis from MI:

acute pericarditis: pathologic Q waves

Answer 12

NO

Question 13

ECG features differentiating acute pericarditis from MI:

myocaridal ischemia: ST-segment contour

Answer 13

conVEX upwards

Question 14

ECG features differentiating acute pericarditis from MI:

myocaridal ischemia: ST-segment lead involvement

Answer 14

LOCALIZED

Question 15

ECG features differentiating acute pericarditis from MI:

myocaridal ischemia: reciprocal ST-T changes

Answer 15

yes

Question 16

ECG features differentiating acute pericarditis from MI:

myocaridal ischemia: PR-segment abnormalities

Answer 16

no

Question 17

ECG features differentiating acute pericarditis from MI:

myocaridal ischemia: pathologic Q waves

Answer 17

yes

Question 18

first-line tx

Answer 18

• aspirin (preferred after MI)
• NSAIDs
• NSAIDs and colchicine

Question 19

which tx is a/w lower rates of tx failure and recurrent pericarditis?

Answer 19

NSAIDs and colchicine

Question 20

tx if pericarditis does NOT respond to aspirin or NSAIDs or is related to AI process

Answer 20

2-3 day course of glucocorticoids

Question 21

when do you tx acute pericarditis w/ steroids?

Answer 21

• NO response to aspirin or NSAIDs

- or related to AI process

Question 22

tx for tamponade or hemodynamic instability

Answer 22

emergent pericardiocentesis