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
- Pneumococcal, meningococcal, TB, treponema pallidum…
- 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
- Systemic sclerosis, SLE, RA
- 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
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