Pericardial Disease / Pericarditis

• What is acute pericarditis?


  It is the inflammation of the pericardium, the sac surrounding the heart.
• What symptom is typically relieved by leaning forward in acute pericarditis?


  Chest pain
• What are some common causes of acute pericarditis?


  Infections, malignancies, cardiac causes, radiation, drugs/toxins, and rheumatological diseases.
• What diagnostic methods are used for acute pericarditis?


  Clinical evaluation, ECG findings, and imaging such as echocardiogram.
• What ECG findings are indicative of acute pericarditis?


  ST elevation and PR depression.
• What treatment options are available for acute pericarditis?


  NSAIDs, colchicine, and corticosteroids depending on the underlying cause.
• What is the prognosis for acute pericarditis?


  The prognosis is generally excellent with a low risk of long-term sequelae.
• What is the definition of acute pericarditis?


  Inflammation of the pericardium, the fibroelastic sac that surrounds the heart.
• What is perimyocarditis?


  Inflammation that extends to the myocardium, the heart muscle.
• How common is acute pericarditis?


  It occurs in approximately 27.7 per 100,000 people annually.
• What are the classifications of causes for pericarditis?

  • Idiopathic
  • Infective causes (viral, bacterial, fungi, parasites)
  • Malignant causes (lung cancer, breast cancer, Hodgkin's lymphoma)
  • Cardiac causes (heart failure, post-cardiac injury syndrome)
  • Radiation
  • Drugs and toxins (e.g., anthracycline chemotherapy)
  • Rheumatological diseases (e.g., SLE, rheumatoid arthritis)
  • Other causes (e.g., renal failure, hypothyroidism)
• Name a viral cause of pericarditis.

  Coxsackie B virus
• Name a bacterial cause of pericarditis.

  Staphylococcus
• What is Dressler's syndrome?


  Post-cardiac injury syndrome that can cause pericarditis.
• What are some symptoms of acute pericarditis?


  Pleuritic chest pain, postural chest pain, and fever.
• What is a pericardial friction rub?


  A high-pitched scratching noise best heard over the left sternal border during expiration.
• What is Beck's Triad?


  Hypotension, raised JVP, and muffled heart sounds indicating cardiac tamponade.
• What are the differential diagnoses for acute pericarditis?


  • Acute Coronary Syndrome
  • Pleuritic Chest Pain (e.g., Pulmonary Embolism, Pneumonia)
  • Musculoskeletal Chest Pain
  • Gastro-oesophageal Reflux Disease (GORD)
• How does pericarditic chest pain differ from acute coronary syndrome (ACS) chest pain?


  Pericarditic pain is sharp, pleuritic, and relieved by sitting forward, while ACS pain is squeezing and not positional.
• What are the clinical features of pneumonia compared to pericarditis?


  Pneumonia presents with a productive cough and fevers, while pericarditis does not.
• How can musculoskeletal pain be differentiated from pericarditis?


  Musculoskeletal pain is reproducible with palpation or certain movements.
• How does GORD pain differ from pericarditic pain?


  GORD pain is described as burning and worsens with certain foods, while pericarditic pain is sharp.
• What investigations aid in the diagnosis of pericarditis?


  • ECG (1st line)
  • Blood tests (serial troponins, inflammatory markers, viral serology)
  • Imaging (echocardiogram, angiogram, cardiac MRI)
• What are the ECG features of pericarditis?


  Widespread saddle ST elevation and PR depression.
• How do troponin levels behave in acute pericarditis?


  They tend to stay consistently elevated in the acute phase.
• What imaging technique is used to assess for pericardial effusion?

  Echocardiogram
• What is the first-line treatment for idiopathic or viral pericarditis?


  Exercise restriction and NSAIDs (+ PPI) for 1-2 weeks.
• What is the second-line treatment for pericarditis?


  Colchicine
• What is the first-line treatment for bacterial pericarditis?


  IV antibiotics +/- pericardiocentesis if purulent exudate is present.
• What is a rare complication of pericarditis?


  Cardiac tamponade
• What long-term complication can occasionally develop after acute pericarditis?

  Constrictive pericarditis
• What percentage of patients with acute pericarditis develop long-term sequelae?


  Less than 0.5%