Pericarditis

• Pericarditis is the inflammation of the pericardium - the double layers sac that surrounds the heart
• Most cases are idiopathic but potential underlying causes include:

  • Infections - viral, bacterial, and fungal
  • Acute myocardial infarction - occurs 1-3 days after a transmural infarction
  • Dressler's syndrome - occurs weeks to months after an MI - autoimmune response triggering systemic inflammation
  • Malignancy - primary (mesotheliomas) or metastatic
  • Autoimmune - collagen or vascular disorders e.g. RA, SLE
  • Drug induced - hydralazine
  • Uraemic - accumulation of toxic metabolites and nitrogenous waste as seen in end-stage renal disease
• Pericarditis causes chest pain that is:

  • Sharp
  • Central - but can be left sided
  • Radiates to the neck, shoulders and arms - radiation to the trapezius ridge is a classic sign
  • Pleuritic - worse on inspiration
  • Worse on lying down
  • Better when leaning forward
• Pericarditis also causes a low grade fever and SOB

  A pericardial rub can be heard on auscultation
• Pericarditis can lead to pericardial effusion and cardiac tamponade

  Becks triad:

  • Hypotension
  • Muffled heart sounds
  • Raised JVP
• Pericarditis will cause saddle shaped ST elevation on an ECG

  An echo can be done to identify pericardial effusion
• Management of pericarditis:

  1. NSAIDs and PPI
  2. Colchicine taken longer term to prevent reoccurrence
  3. Steroids only for recurrent cases or associated with inflammatory conditions
• A large effusion or cardiac tamponade requires urgent pericardiocentesis
• Risk factors:

  • Age: 41-60 years, advancing age is a risk factor for bacterial pericarditis
  • Male sex
  • Steroids
• Additional risk factors for bacterial pericarditis:

  • Diabetes
  • Extensive burn injuries
  • Systemic infections
  • Immunosuppression
  • Heart surgery
  • Chest trauma
  • Pre-existing pericardial effusion
• Clinical findings:

  • Pericardial rub - due to friction between the pericardial layers, typically loudest at the left lower sternal border, best heard with the patient leaning forward
  • Evidence of pericardial effusion - usually not symptomatic unless large, may hear soft/distant heart sounds