Pericarditis - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-01-28T20:42:11Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 20:42, 28 January 2022
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	***Others: [[Chlamydia psittaci]], [[Chlamydia trachomatis]], [[Legionella]], [[Salmonella]], [[Borrelia burgdorferi]], [[Mycoplasma]], [[Actinomyces]], [[Nocardia]], [[Tropheryma whipplei]], [[Treponema]], [[Rickettsia]], [[Listeria]]		***Others: [[Chlamydia psittaci]], [[Chlamydia trachomatis]], [[Legionella]], [[Salmonella]], [[Borrelia burgdorferi]], [[Mycoplasma]], [[Actinomyces]], [[Nocardia]], [[Tropheryma whipplei]], [[Treponema]], [[Rickettsia]], [[Listeria]]
	**Fungal: ''[[Histoplasma]] (most common fungal cause)'', ''Aspergillus'', ''Blastomyces'', ''Coccidioides'', ''Candida''		**Fungal: ''[[Histoplasma]] (most common fungal cause)'', ''Aspergillus'', ''Blastomyces'', ''Coccidioides'', ''Candida''
	**Parasitic: [[Echinococcus]], [[Entamoeba histolytica]], [[Toxoplasma]], [[Schistosoma ~~species~~]]		**Parasitic: [[Echinococcus]], [[Entamoeba histolytica]], [[Toxoplasma]], [[Schistosoma]]
	*Non-infectious		*Non-infectious
	**Malignancy		**Malignancy

Aidan: /* Investigations */

2020-08-19T00:55:45Z

Investigations

← Older revision		Revision as of 00:55, 19 August 2020
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	*Labs: lytes/creatinine (for NSAID safety), troponins		*Labs: lytes/creatinine (for NSAID safety), troponins
	*Echocardiogram		*Echocardiogram
			*ECG, which evolves over weeks
	*ECG
	**Stage I: diffuse ST elevation with PR depression		**Stage I: diffuse ST elevation with PR depression
	**Stage II: normalization of ST and PR segments		**Stage II: normalization of ST and PR segments
	**Stage III: diffuse deep T-wave inversions		**Stage III: diffuse deep T-wave inversions
	**Stage IV: normalization of the ECG		**Stage IV: normalization of the ECG
			**May show electrical alternans with large pericardial effusions

	==Diagnosis==		==Diagnosis==
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	*Based on 2 of 4 features:		*Based on 2 of 4 features:
	**Positional chest pain		**Positional chest pain
	**EKG abnormalities		**Characteristic EKG abnormalities
			**Characteristic findings on echocardiography
	***PR depression, then diffuse ST elevation with upsloping, then ST depression, then T-wave inversions, then T-wave normalization
	***Evolves over weeks
	**Echocardiography
	**Rub on auscultation		**Rub on auscultation

Aidan: /* Microbiology */

2020-08-19T00:54:03Z

Microbiology

← Older revision		Revision as of 00:54, 19 August 2020
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	***Others: [[Chlamydia psittaci]], [[Chlamydia trachomatis]], [[Legionella]], [[Salmonella]], [[Borrelia burgdorferi]], [[Mycoplasma]], [[Actinomyces]], [[Nocardia]], [[Tropheryma whipplei]], [[Treponema]], [[Rickettsia]], [[Listeria]]		***Others: [[Chlamydia psittaci]], [[Chlamydia trachomatis]], [[Legionella]], [[Salmonella]], [[Borrelia burgdorferi]], [[Mycoplasma]], [[Actinomyces]], [[Nocardia]], [[Tropheryma whipplei]], [[Treponema]], [[Rickettsia]], [[Listeria]]
	**Fungal: ''[[Histoplasma]] (most common fungal cause)'', ''Aspergillus'', ''Blastomyces'', ''Coccidioides'', ''Candida''		**Fungal: ''[[Histoplasma]] (most common fungal cause)'', ''Aspergillus'', ''Blastomyces'', ''Coccidioides'', ''Candida''
	**Parasitic: [[Echinococcus]], [[~~amoebae~~]], [[Toxoplasma]]		**Parasitic: [[Echinococcus]], [[Entamoeba histolytica]], [[Toxoplasma]], [[Schistosoma species]]
	*Non-infectious		*Non-infectious
	**Malignancy		**Malignancy
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	*Positional chest pain, often several weeks following viral infection (most commonly [[Coxsackievirus]])		*Positional chest pain, often several weeks following viral infection (most commonly [[Coxsackievirus]])

	=== Prognosis and Complications ===		===Prognosis and Complications===

	==== Recurrent Pericarditis ====		====Recurrent Pericarditis====

	* Pericarditis recurs in 15 to 30% of patients		*Pericarditis recurs in 15 to 30% of patients

	==== Constrictive Pericarditis ====		====Constrictive Pericarditis====

	* Scarring a loss of elasticity of the pericardium following pericarditis		*Scarring a loss of elasticity of the pericardium following pericarditis

	==== Cardiac Tamponade ====		====Cardiac Tamponade====

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

	== Differential Diagnosis ==		==Differential Diagnosis==

	* Other causes of [[acute chest pain]]		*Other causes of [[acute chest pain]]

	== Investigations ==		==Investigations==

	*Labs: lytes/creatinine (for NSAID safety), troponins		*Labs: lytes/creatinine (for NSAID safety), troponins

Aidan at 00:53, 19 August 2020

2020-08-19T00:53:27Z

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-23T00:27:18Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 00:27, 23 July 2020
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	** Radiation		** Radiation

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

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

Maintenance script: Imported from text file

2020-07-04T01:17:49Z

Imported from text file

New page

== Definition ==

* Inflammation or infection of the pericardia sac

== Etiology ==

* '''Idiopathic''' (most common)
* Infectious
** Viral
*** '''Coxsackievirus'''
*** Echovirus
*** Adenovirus
*** Others: Epstein-Barr virus, cytomegalovirus, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19, vaccinia (smallpox vaccine)
** Mycobacterial: '''tuberculosis'''
** Bacterial
*** ''Staphylococcus aureus''
*** ''Streptococcus pneumoniae''
*** ''Haemophilus influenzae''
*** ''Neisseria meningitidis''
*** Others: ''Chlamydia psittaci'' and ''C. trachomatis'', ''Legionella'', ''Salmonella'', ''Borrelia burgdorferi'', ''Mycoplasma'', ''Actinomyces'', ''Nocardia'', ''Tropheryma whippelii'', ''Treponema'', ''Rickettsia'', ''Listeria''
** Fungal: ''Histoplasma'', ''Aspergillus'', ''Blastomyces'', ''Coccidioides'', ''Candida''
** Parasitic: ''Echinococcus'', amebic, ''Toxoplasma''
* Non-infectious
** Malignancy
*** Primary: rhabdomyosarcoma, teratoma, fibroma, lipoma, leiomyoma, angioma
*** '''Metastatic''': lung, breast, Hodgkin lymphoma, leukemia, melanoma
** Autoimmune
** Post-MI: either early or late (Dressler syndrome)
** Metabolic: '''uremia''', hypothyroidism
** Radiation

== Clinical Presentation ==

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

== Diagnosis ==

* Based on 2 of 4 features
* Positional chest pain
* EKG shows PR depression, then diffuse ST elevation with upsloping, then ST depression, then T-wave inversions, then T-wave normalization
** Evolves over weeks
* Echo
* Rub

== Investigations ==

* Labs: lytes/creatinine (for NSAID safety), troponins
* Echocardiogram
* ECG
** 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

[[File:Cl4sECGevoacuteprcrdts.jpg|Evolution of ECG in pericarditis]]

== 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

[[Category:Cardiology]]
[[Category:Infectious diseases]]