“An inflammation of the pericardium, the lining around the heart”

Risk Factors
  • Male aged 20 to 50
  • Recent MI
  • Recent viral infection
  • Autoimmune disease
  • Kidney failure
  • Trauma or surgery
  • Rarely, medications such as phenytoin or procainamide.
Aetiology
  • Idiopathic
  • Post-viral infection
  • Less common:
    • Other infections (TB)
    • Autoimmune disorders
    • MI (Dressler syndrome)
    • Heart surgery,
    • Renal failure(uremic),
    • Cancer
Pathophysiology
  • Inflammation:
    • Release of inflammatory mediators (PGs) → fever and pain → infiltration of immune cells → thickening of pericardial tissue.
  • Further progression:
    • ↓ fluid removal by serous layer → ↑­ fluid in pericardial space → effusion → compression of the heart → tamponade
  • Chronic:
    • ↑ WBC in pericardial space + fibrin strands → fibrosis/constrictive pericarditis
Clinical Presentation
  • Sharp/stabbing or dull precordial chest pain
    • Worse when lying down or taking a deep breath
    • May be sudden or gradual in onset
  • May also include:
    • Fever
    • Dyspnoea/tachypnoea
    • Cough
    • Dysphagia
Investigations
  • On Examination:
    • Pericardial friction rub
  • Bloods:
    • Troponin, ESR, CRP, FBC, urea
  • Imaging:
    • Chest X-Ray – Any pericardial effusion?
    • Echocardiogram – Any pericardial effusion or damage?
  • Special:
    • ECG – serial changes of ST-elevation + PR depression → flatten T wave → T wave depression → normal
    • Pericardial fluid aspiration
    • Pericardial biopsy
Management
  • NSAID + PPI (GI protection)
  • colchicine +/- corticosteroids for recurrent pericarditis
  • Pericardiocentesis: symptomatic effusion and tamponade
  • Pericardiectomy: constrictive pericarditis
Complications
  • Pericardial effusion, possibly leading to cardiac tamponade
  • Constrictive pericarditis

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