what is the definition of pericarditis?
Acute inflammation of the pericardium; with or without effusion
what is the epidemiology of pericarditis?
- Majority are idiopathic and most commonly seen in the young, previously healthy patient
- Occurs in men more than women
- Occurs in adults more than children
what is the aetiology of pericarditis?
Infectious:
- Viral (common):
• Enteroviruses e.g. coxsackieviruses & echoviruses
• Adenoviruses
- Bacterial:
• Mycobacterium tuberculosis (other bacteria are rare)
- Fungal (very rare):
• Histoplasma spp. - most likely to be seen in immunocompromised patient
Non-infectious:
- Autoimmune (common):
• Sjorgrens syndrome
• Rheumatoid arthritis
• SLE
- Neoplastic; secondary metastatic tumours (common, above all is lung or breast cancer)
- Dressler’s syndrome - post cardiac injury syndromes
- Traumatic & iatrogenic:
• Early onset (rare):
- Direct injury - penetrating thoracic injury or oesophageal perforation
- Indirect injury - non-penetrating thoracic injury or radiation
• Delayed onset (common):
- Pericardial injury syndromes (common)
- Iatrogenic trauma e.g. coronary percutaneous intervention or pacemaker lead insertion
what are the risk factors for pericarditis?
previous MI, autoimmune disease, trauma, infections, kidney failure, medications treating seizure and irregular heartbeats
what is the pathophysiology of pericarditis?
Pericardium becomes acutely inflamed, with pericardial vascularisation and infiltration with polymorphonuclear leukocytes
A fibrinous reaction frequently results in exudate and adhesions within the pericardial sac, and a serous or haemorrhagic effusion may develop
what are the key presentations for pericarditis?
Chest pain, relieved when sitting up, worse when lying flat, pericardial rub
what are the signs of pericarditis?
Tachycardia, pericardial friction rub, lymphocytosis
what are the symptoms of pericarditis?
Chest pain - Rapid onset, serve pain, worse on inspiration and lying flat, left anterior chest or epigastric, radiates to arm Dyspnea Cough Hiccups fever myalgias
what are the first line and gold standard investigations for pericarditis?
ECG - saddle shaped ST elevation, diffuse ST segment elevation present in all leads, PR depression
FBC - Slight increase in white cell count
Anti Neutrophil Antibody in young females - SLE
Troponin - elevated suggests myopericarditis
ESR/CRP - High ESR is indicative of autoimmune
pericardiocentesis -acid-fast bacilli, positive culture of Mycobacterium tuberculosis
CXR:
• May demonstrate cardiomegaly in cases of effusion - if found then confirm with echocardiography
• Often normal in idiopathic
• Pneumonia is common with bacterial pericarditis
what are the differential diagnoses for pericarditis?
- Angina
- MI - most important to rule out
- Pleuritic pain
- Pulmonary infarction
- Pneumonia, GI reflux, peritonitis & aortic dissection
how is pericarditis managed?
- Restrict physical activity until resolution of symptoms and see improvement in ECG and CRP
- NSAID e.g Ibuprofen for two weeks or Aspirin for two weeks
- Colchicine for 3 weeks however is limited by nausea and diarrhoea but does reduce recurrence
• Recurrent or relapsing pericarditis: - About 20% of cases of acute pericarditis go on to develop idiopathic relapsing pericarditis
- This may occur within 6 weeks during weaning off NSAIDs or intermittently
i.e. recurs more than 6 weeks after the initial presentation - The first line treatment is oral NSAIDs e.g. Ibuprofen
- Colchicine has been proven to be more effective than Aspirin alone
- In resistant cases, oral corticosteroids e.g. Prednisolone may be effective, and in some patients, pericardiectomy (removal of part/most of the pericardium) may be appropriate
how is pericarditis monitored?
Repeat ECGs and CRP to check for relapsing pericarditis
what are the complications of pericarditis?
Chronic pericarditis, thickening / scarring of pericardium, prevents the heart from filling and emptying properly. Swelling of legs and abdomen, shortness of breath, tamponade (fluid puts pressure on heart)
what is the prognosis for pericarditis?
Acute or idiopathic usually good prognosis and low likelihood of developing tamponade
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Angina15
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Hypertension14
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Heart failure14
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Myocardial Infarction15
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Acute Coronary Syndrome13
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Mitral Stenosis15
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Mitral Regurgitation15
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Aortic Stenosis14
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Aortic Regurgitation14
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Infective endocarditis13
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Pericarditis14
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Cardiac tamponade14
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Pericardial effusion9
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Peripheral arterial disease14
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Cardiomyopathy6
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Cardiology Pharmacology7
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mock questions74
