Pericarditis

Question 1

define pericarditis?

Answer 1

• it is the inflammation of the pericardium

- can be categorized as acute, subacute, or chronic

Question 2

what is the epidemiology of pericarditis?

Answer 2

• it is uncommon
• makes up <1/100 hospital admissions
• more common in males than females
• common in late summertime

Question 3

what are the risk factors of pericarditis?

Answer 3

• idopathic
• infective
• connective tissue disease
• post MI (common)
• Dresslers syndrome
• malignancy
• radiotherapy
• thoracic surgery
• drugs

Question 4

what are the most common causative organisms?

Answer 4

Coxsackie B
Echovirus
Mumps
Streptococci
Staphylococci
TB
Fungi

Question 5

what are the presenting symptoms of pericarditis?

Answer 5

• sharp chest pain which is worse on breathing in and relieved on sitting forwards
• dyspnoea
• nausea

Question 6

Recognize the signs of pericarditis on physical examination?

Answer 6

• fever
• pericardial friction rub
• faint heart sounds due to pericardial effusion

Question 7

where is pericardial friction rub best listened to?

Answer 7

• it is best heard on the lower left sternal edge with the patient leaning forward on expiration.

Question 8

what are the signs of cardiac tamponade?

Answer 8

- Becks triad = 
raised JVP 
low BP 
muffled heart sounds 
- tachycardia
- pulsus paradoxus

Question 9

what is pulsus paradoxus?

Answer 9

it is an abnormally large decrease in SBP and pulse amplitude during INSPIRATION.

Question 10

what are the best investigations for pericarditis?

Answer 10

• ECG
• echocardiogram
• bloods
• CXR

Question 11

what will be seen on ECG?

Answer 11

widespread saddle-shaped ST elevation

Question 12

what does the echocardiogram assess?

Answer 12

the extent of pericardial effusion and assesses the cardiac function

Question 13

which bloods should be ordered?

Answer 13

• FBC
• Us and Es
• ESR/CRP
• cardiac enzymes (this is normal)
• blood cultures

Question 14

what will the CXR show?

Answer 14

• it is usually normal

- can be globular if there is pericardial effusion.

Question 15

what is the management plan for pericarditis?

Answer 15

• acute: cardiac tamponade is treated with emergencypericardiocentesis
• medical: treat the underlying cause
• use NSAIDs for pain and fever relief

Question 16

how to treat recurrent pericarditis?

Answer 16

• low dose steroids
• immunosuppressants
• colchicine

Question 17

what are the complications of pericarditis?

Answer 17

• pericardial effusion
• cardiac tamponade
• cardiac arrhythmia’s

Question 18

what is the prognosis of patients with pericarditis?

Answer 18

• depends on the underlying cause
• viral cases have a very good prognosis
• malignant pericarditis has a poor prognosis.