Updated: 4/19/2021

Pericarditis

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
12
0
0
0%
0%
Evidence
19
0
0
Topic
Snapshot
  • A 60-year-old woman presents with chest pain. She reports the chest pain started today and describes it as sharp and brief. When she sits up, the pain improves. She has no significant past medical history but endorses a viral respiratory infection a few days ago.  On physical exam, she is in no acute distress. She has a low-grade fever. An electrocardiogram shows widespread ST segment elevation and PR depression in the precordial leads. 
Introduction
  • Clinical definition
    • inflammation of the pericardium characterized by sharp pain worsened by inhalation
  • Etiology
    • serous
      • autoimmune disease
        • systemic lupus erythematosus
        • rheumatoid arthritis
      • uremia
      • viral illness
        • coxsackievirus
    • fibrinous pericarditis 
      • complication of myocardial infarction
        • 1-3 days after and several weeks after (Dressler syndrome)
      • uremia
      • rheumatic fever
    • hemorrhagic
      • tuberculosis
      • malignancy
    • constrictive
      • radiation therapy
      • open heart surgery
      • viral illness
      • tuberculosis
  • Pathogenesis
    • inflammation of the pericardium can cause chest pain
    • movement of the heart can cause friction between the 2 pericardial layers, producing a friction rub
    • inflammation may cause a pericardial effusion 
  • Prognosis
    • can be acute or chronic and may recur
    • viral pericarditis is usually self-limited
Presentation
  • Symptoms
    • sharp pleuritic chest pain that is worsened by inhalation
      • pain is also relieved by sitting up and leaning forward
    • shoulder pain (referred pain)
      • pericarditis is innervated by phrenic nerve
    • hypotension, tachycardia, pulsus paradoxus, and impaired diastolic filling in constrictive pericarditis  
  • Physical exam
    • may have a fever
    • friction rub
      • pathognomonic
    • Kussmaul sign 
      • seen in constrictive pericarditis
      • ↑ jugular venous distention on inspiration
Imaging
  • Transthoracic Echocardiography
    • indication
      • to assess for pericardial effusion and cardiac tamponade
  • Radiography
    • indication
      • to rule out pneumonia or other pulmonary pathology
    • findings
      • constrictive pericarditis may have pericardial calcifications on radiography
Studies
  • Labs
    • ↑ erythrocyte sedimentation rate
    • ↑ C-reactive protein
    • may have ↑ troponin I
  • Electrocardiogram (ECG) 
    • PR segment depression, especially in lead II and in all leads except aVR
    • widespread ST segment elevation
    • upright T waves
      • weeks after pericarditis, this will become inverted T waves
    • classic ECG signs may be absent in uremic pericarditis 
  • Making the diagnosis
    • based on clinical presentation and ECG findings
Differential
  • Cardiac tamponade
    • distinguishing factor
      • pulsus paradoxus and Beck triad on exam
  • Myocardial infarction
    • distinguishing factor
      • more focal ST elevation on ECG suggestive of anatomic damage
Treatment
  • Nonoperative
    • observation and treatment of the underlying cause
      • indications
        • in cases of asymptomatic or small pericardial effusion
      • medical treatment
        • NSAIDS
          • for viral pericarditis
        • steroids and immunosuppressants
          • for SLE
          • avoid immediately following MI to protect from ventricular wall rupture
        • dialysis  
          • for uremia
        • aspirin  
          • for post-MI pericarditis 
    • pericardiocentesis
      • indications
        • required for large effusions and cardiac tamponade
  • Operative
    • pericardiectomy
      • reserved for recurrent disease
Complications
  • Pericardial effusion and tamponade

Please rate topic.

Average 4.8 of 11 Ratings

Questions (12)
Evidence (19)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (19)
Private Note