Malady Wise

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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