Pericarditis
Epidemiology
1 in 1000 hospitalised patients
5% of non-ischaemic chest pain presentation to ED
Features
Chest pain (95%)
Sharp
Pleuritic
Improved by sitting up and leaning forward
Often relatively sudden onset
Anterior chest
Radiation to trapezius
Pericardial friction rub (85%)
Superficial scratchy or squeaking sound
Left sternal border
ECG
Stage 1 - First hours to days
New widespread ST elevation (typically concave up)
Reciprocal ST depression in aVR and V1
PR depression - often V5 and V6
Stage 2 - First week
Normalisation
Stage 3 -
Diffuse T wave inversion
Stage 4
Effusion
Common but not required to diagnoses
Diagnostic Approach
History
Consider malignancy, autoimmune disorders, uraemia, recent MI and previous heart surgery
Exam
As above
Tests
ECG
CXR
FBC, Trop, ESR, CRP
Echo
Urgent if cardiac tamponade suspected
Additional testing if indicated
Blood cultures
Viral studies Hep B + C
ANA if ? autoimmune disease
TB
Diagnosis = at least 2 of
Typical pain
Friction rub
ECG changes
New or worsening effusion
Cause
As usual benign course, not necessary most of the time
For acute pericarditis
Cancer = 5%
TB = 4%
Autoimmune = 5%
Purulent = 1%
Treatment
Restrict strenuous activity until symptoms resolved
Colchicine (3 months) + NSAIDs tapering