Pericarditis

Last Updated on by frcemuser

OVERVIEW

  • Pericarditis = inflammation in the pericardium

CAUSES

  • uraemia
  • viral infection (coxsackievirus, echovirus, mumps, Epstein-Barr virus, cytomegalovirus, varicella, rubella, HIV, Parvovirus B19)
  • bacterial infection
  • radioation
  • malignancy (metastatic: lung>breast>leukaemia and lymphoma>melanoma)
  • vasculitis
  • autoimmune (SLE, RA, scleroderma, sarcoid…)
  • Tb
  • other

ASSESSMENT

HISTORY

  • chest pain (sharp, dull, burning, pressing, radiation -> trapezius ridge, worse on inspiration, lying flat and movement)
  • SOB
  • fever

EXAMINATION

  • pericardial rub (most are triphasic)
  • tachypnoea
  • tachycardia
  • fever

INVESTIGATIONS

  • ECG (4 stages):
    1. diffuse ST elevation with PR depression
    2. resolution of stage 1 with T Wave flattening
    3. deep symmetrical T Wave  inversion
    4. resolution
  • cardiac enzymes (30% elevated)
  • CXR: if tamponade suspected
  • ECHO: gold standard

MANAGEMENT

  • R/O life-threatening causes of chest pain
  • NSAIDs are given first line for 4 weeks. Colchicine is recommended as a first-line adjunct therapy to NSAIDs as it improves response, decreases recurrences, and increases remission rates. It is given for 3 months in this setting.  corticosteroid can be considered as an option in patients who do not respond to anti-inflammatory therapy, or for patients in whom an NSAID is contraindicated
  • tamponade -> pericardiocentesis
  • if infectious: antibiotics
  • many managed as an outpatient
  • cardiology and cardiothoracic opinion if indicated

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