Cardiovascular System >
Pericarditis
“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