Pericarditis

Question 1

Definition of pericarditis

Answer 1

Inflammation of pericardium with (wet - MC) or without (dry - fibrinous) effusion

Question 2

Causes of pericarditis?

Answer 2

Idiopathic

Infection:
viral (*coxsackie B virus) - MC
Bacteria (TB - strep pneumoniae, staph aureus)
Fungal - rare - histoplasmosis, immunocompromised patient

Non infectious:
*Dressler’s syndrome- post MI
Autoimmune- SLE, Sjorgen’s, RA (common)
Neoplastic (lung, breast)

Question 3

Pathology of pericarditis

Answer 3

Inflamed pericardial layers rub against each other (as narrowed pericardial space narrowed with inflammation)& exacerbate further inflammation

This may remain dry (no extra fluid; not as bad, don’t end to compensate for friction) or become effusive (extra fluid needed to compensate for friction )

Question 4

Signs and symptoms of pericarditis
what is heard on examination?

Answer 4

Severe sharp pleuritic chest pain radiating to left shoulder tip (trapezius ridge - phrenic) / neck, shoulders, back
- Worse lying flat or taking a deep breath
- Relieved by sitting up & leaning forwards

Flu like Sx

o/e:
Pericardial friction rub in auscultation- heard when patient leans forwards, squeaky leather to and fro sound

Question 5

Diagnosis of pericarditis

Answer 5

ECG (diagnostic):
- widespread saddle shaped ST elevation
- PR depression - MC

Chest x ray:
may show ‘water bottle’ heart (cardiomegaly)
pneumonia commonly seen (bacterial pericarditis - TB)

High ESR = seen in autoimmune

High WCC (white cell count) = in infection

Question 6

What is the most key rule out disease in pericarditis?

Answer 6

MI
Central crushing chest pain not related to lying down, no pericardial rub

Question 7

Treatment for pericarditis?

Answer 7

NSAIDS (eg. ibuprofen 600-800mg TDS) for 1-2 weeks
AND
Colchicine (anti inflammatory, 0.5mg BD) for 3 months

Consider Antibiotics if bacterial (RIPE for TB)

Question 8

Complications of pericarditis?

Answer 8

Pericardial effusion = cardiac tamponade, myocarditis, constrictive pericarditis

Question 9

What is constructive pericarditis?

Answer 9

Visceral pericardium becomes more fibrous (granulation tissue formation) - becomes more stiff, impairs diastolic filling - late complication of acute pericarditis + sign of poor heart prognosis

Harder for hearts to fill with blood = low CO = heart failure (RHS) - increased pulmonary BP Fluid in lungs, increased blood in venous circulation

Question 10

Sx of constrictive pericarditis?

Answer 10

SOB,
loud S3,
Pericardiac knock,
Kussmaul JVP sign (paradoxical increase JVP on inspiration due to low filling, usually low JVP)

Question 11

Dx and Tx of constrictive pericarditis?

Answer 11

Chest xray = pericardial calcification

HF management
definitive = pericardectomy