Pericarditis

Epidemiology

• 1 in 1000 hospitalised patients

• 5% of non-ischaemic chest pain presentation to ED

Features

• Chest pain (95%)

  • Sharp

  • Pleuritic

  • Improved by sitting up and leaning forward

  • Often relatively sudden onset

  • Anterior chest

  • Radiation to trapezius

• Pericardial friction rub (85%)

  • Superficial scratchy or squeaking sound

  • Left sternal border

  • Audio Example

• ECG

  • Stage 1 - First hours to days

    • New widespread ST elevation (typically concave up)

    • Reciprocal ST depression in aVR and V1

    • PR depression - often V5 and V6

  • Stage 2 - First week

    • Normalisation

  • Stage 3 -

    • Diffuse T wave inversion

  • Stage 4

• Effusion

  • Common but not required to diagnoses

Diagnostic Approach

• History

  • Consider malignancy, autoimmune disorders, uraemia, recent MI and previous heart surgery

• Exam

  • As above

• Tests

  • ECG

  • CXR

  • FBC, Trop, ESR, CRP

• Echo

  • Urgent if cardiac tamponade suspected

Additional testing if indicated

• Blood cultures

• Viral studies Hep B + C

• ANA if ? autoimmune disease

• TB

Diagnosis = at least 2 of

• Typical pain

• Friction rub

• ECG changes

• New or worsening effusion

Cause

• Pericarditis Causes

• As usual benign course, not necessary most of the time

• For acute pericarditis

  • Cancer = 5%

  • TB = 4%

  • Autoimmune = 5%

  • Purulent = 1%

Treatment

• Restrict strenuous activity until symptoms resolved

• Colchicine (3 months) + NSAIDs tapering