Acute pericarditis

Classification and Aetiology

• Largely based on the type of pericardial effusion produced by the inflammation
  • Serous
    • Usually secondary to connective tissue disorders e.g. Rheumatoid arthritis and SLE
  • Fibrous (most common)
    • Acute MI
    • Uraemia, radiation
    • RA, SLE
    • Viral infection
      • Coxsackie B virus
  • Purulent/Suppurative (i.e. bacterial infection)
    • Can be an extension of pulmonary disease (strep pneumoniae) or haematogenous spread or via trauma (other causes include spread from other local infections e.g. abscesses)
    • Tuberculosis can cause pericarditis
  • Haemorrhagic
    • Can be caused by tuberculosis or malignancy

Presentation

• Classically retrosternal chest pain that radiates to the shoulders and neck
  • Worse on deep inspiration/expiration, movement, change of position (particularly lying flat), exercise and swallowing
  • Relieved by sitting forward
• Fever
• Pericardial friction rub (high-pitched superficial scratching or crunching- listen here) (occurs in 60-85%)
• Other signs include tachypnoea/dyspnoea/orthopnoea; tachycardia; palpitations

Investigations

• ECG
  • ST-elevation with upward concavity (ST-depression in aVR/V1)
    • Found throughout most leads
  • PR interval depression
  • Later, ST segment may normalise and T-waves may flatten and eventually invert
• CXR
  • Flask-shaped cardiac silhouette
• Echo
• Blood
  • FBC (WCC/leukocytosis)
  • PV/CRP
  • U&Es (uraemia)
  • Cardiac enzymes
  • Blood cultures

Management

• Aspirin and/or naproxen/indometacin
  • Colchicine or steroids may suppress symptoms but have not been shown to accelerate recovery
• Viral cases will usually spontaneously resolve within a few days
• Bacterial cases may require antibiotics, pericardiocentesis and possibly surgical drainage
• NB Thrombolysis and anticoagulation is contraindicated because it may cause haemopericardium and cardiac tamponade (due to rupture and bleeding of vessels of the pericardium)

Advertisement