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