Pericarditis

From IDWiki

Background

  • Inflammation or infection of the pericardial sac

Microbiology

Clinical Manifestations

  • Positional chest pain, often several weeks following viral infection (most commonly Coxsackievirus)

Prognosis and Complications

Recurrent Pericarditis

  • Pericarditis recurs in 15 to 30% of patients

Constrictive Pericarditis

  • Scarring a loss of elasticity of the pericardium following pericarditis

Cardiac Tamponade

  • Accumulation of pericardial effusion resulting in increased intrapericarial pressure causing heart failure

Differential Diagnosis

Investigations

  • Labs: lytes/creatinine (for NSAID safety), troponins
  • Echocardiogram
  • ECG, which evolves over weeks
    • Stage I: diffuse ST elevation with PR depression
    • Stage II: normalization of ST and PR segments
    • Stage III: diffuse deep T-wave inversions
    • Stage IV: normalization of the ECG
    • May show electrical alternans with large pericardial effusions

Diagnosis

  • Based on 2 of 4 features:
    • Positional chest pain
    • Characteristic EKG abnormalities
    • Characteristic findings on echocardiography
    • Rub on auscultation

Management

  • Mainstay of treatment is NSAIDs for 1-2 weeks, tapered over another 2-3 weeks
    • ASA 650mg po qid with pantoprazole
    • Indomethacin
  • Adjunctive colchicine for 3 months
  • If refractory or NSAID allergy: steroids with a slow taper
    • Increased recurrence rate