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Pericarditis

Pericarditis is inflammation of the pericardium of the heart.

Presentation 
  • Pleuritic chest pain, improved on leaning forward and worse on lying supine, may radiate to trapezius
  • Prodromal illness

Aetiology: 
  • Viral infection 
    • Coxsackie, EBV, HIV, Influenza, CMV...
  • Bacterial infection 
  • Fungal infection
  • Acute MI – especially anterior MI 
    • Early = pericarditis epistenocardica = caused by direct exudation in a transmural infarct 
    • Delayed = Dressler’s syndrome – occurs one week to several months after MI 
  • Malignancy 
    • Most commonly lung, breast or leukaemia/lymphoma 
  • Renal failure 
  • Autoimmune 
  • Hypothyroidism 
  • Medications 
    • Dantrolene, doxorubicin, isoniazid, rifampicin, mesalamine, penicillin, phenytoin, hydralazine, amiodarone, streptokinase… 

Investigations
  • ECG 
    • Saddle-shaped ST elevation, reciprocal PR segment elevation and ST depression in aVR and occasionally V1, T wave inversions 
  • Auscultation may reveal a pericardial rub 
  • Echo 
  • CXR 
    • ?'water bottle’ heart shadow 
  • Bloods 
    • ESR, CRP, LDH, FBC, troponin

Treatment 
  • NSAIDs 
  • ?Colchicine
  • Corticosteroid for pericarditis caused by connective tissue disease and renal failure. 

Complications 
  • Pericardial effusion (60% of cases) 
  • Cardiac tamponade (5% of cases) 
  • Recurrent pericarditis 
  • Constrictive peridcarditis 


References:
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Abdelghafour

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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)