Pericarditis: Difference between revisions
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− | == |
+ | ==Background== |
− | * |
+ | *Inflammation or infection of the pericardial sac |
− | == |
+ | ==Microbiology== |
− | * |
+ | *'''Idiopathic''' (most common) |
− | * |
+ | *Infectious |
− | ** |
+ | **Viral |
− | *** |
+ | ***'''[[Coxsackievirus]] A and B''' |
− | *** |
+ | ***[[Echovirus]] 8 |
− | *** |
+ | ***[[Adenovirus]] |
− | *** |
+ | ***Others: [[Epstein-Barr virus]], [[cytomegalovirus]], [[influenza]], [[varicella]], [[rubella]], [[HIV]], [[hepatitis B]], [[mumps]], [[parvovirus B19]], [[vaccinia virus]] (smallpox vaccine) |
− | ** |
+ | **Mycobacterial: '''[[Mycobacterium tuberculosis]]''' |
− | ** |
+ | **Bacterial |
− | *** |
+ | ***[[Staphylococcus aureus]] |
− | *** |
+ | ***[[Streptococcus pneumoniae]] |
− | *** |
+ | ***[[Haemophilus influenzae]] |
− | *** |
+ | ***[[Neisseria meningitidis]] |
− | *** |
+ | ***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'' |
− | ** |
+ | **Parasitic: [[Echinococcus]], [[Entamoeba histolytica]], [[Toxoplasma]], [[Schistosoma]] |
− | * |
+ | *Non-infectious |
− | ** |
+ | **Malignancy |
− | *** |
+ | ***Primary: [[rhabdomyosarcoma]], [[teratoma]], [[fibroma]], [[lipoma]], [[leiomyoma]], [[angioma]] |
− | *** |
+ | ***'''Metastatic''': [[Lung cancer|lung]], [[Breast cancer|breast]], [[Hodgkin lymphoma]], [[leukemia]], [[melanoma]] |
− | ** |
+ | **Autoimmune disorders |
− | ** |
+ | **Post-MI: either early or late ([[Dressler syndrome]]) |
− | ** |
+ | **Metabolic: '''uremia''', [[hypothyroidism]] |
− | ** |
+ | **Radiation |
− | == |
+ | ==Clinical Manifestations== |
− | * |
+ | *Positional chest pain, often several weeks following viral infection (most commonly [[Coxsackievirus]]) |
+ | ===Prognosis and Complications=== |
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+ | ====Recurrent Pericarditis==== |
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− | * EKG shows PR depression, then diffuse ST elevation with upsloping, then ST depression, then T-wave inversions, then T-wave normalization |
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− | * Echo |
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− | * Rub |
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+ | *Pericarditis recurs in 15 to 30% of patients |
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+ | ====Constrictive Pericarditis==== |
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− | * ECG |
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+ | *Scarring a loss of elasticity of the pericardium following pericarditis |
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− | [[File:Cl4sECGevoacuteprcrdts.jpg|Evolution of ECG in pericarditis]] |
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+ | ====Cardiac Tamponade==== |
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+ | *Accumulation of pericardial effusion resulting in increased intrapericarial pressure causing heart failure |
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+ | |||
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+ | ==Differential Diagnosis== |
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+ | |||
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+ | *Other causes of [[acute chest pain]] |
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+ | |||
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+ | **May show electrical alternans with large pericardial effusions |
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+ | |||
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+ | |||
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+ | **Characteristic EKG abnormalities |
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+ | **Characteristic findings on echocardiography |
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+ | **Rub on auscultation |
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+ | |||
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[[Category:Cardiology]] |
[[Category:Cardiology]] |
Latest revision as of 16:42, 28 January 2022
Background
- Inflammation or infection of the pericardial sac
Microbiology
- Idiopathic (most common)
- Infectious
- Viral
- Coxsackievirus A and B
- Echovirus 8
- Adenovirus
- Others: Epstein-Barr virus, cytomegalovirus, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19, vaccinia virus (smallpox vaccine)
- Mycobacterial: Mycobacterium tuberculosis
- Bacterial
- Fungal: Histoplasma (most common fungal cause), Aspergillus, Blastomyces, Coccidioides, Candida
- Parasitic: Echinococcus, Entamoeba histolytica, Toxoplasma, Schistosoma
- Viral
- Non-infectious
- Malignancy
- Autoimmune disorders
- Post-MI: either early or late (Dressler syndrome)
- Metabolic: uremia, hypothyroidism
- Radiation
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
- Other causes of acute chest pain
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