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Acute Pericarditis

Title               

Ñ    Acute Pericarditis

Definition

Ñ    Inflammation of the pericardium of  < 6 weeks duration

Pathogenesis

Causes

Internal factors

Viral Infections

Ñ    Coxsackie

Ñ    Echo

Bacterial Infections

Ñ    Following septicaemia, pneumonia:

Staphylococcus, Haemophilus influenzae

Ñ    Mycoplasma, Lyme disease, Chlamydia

Ñ    Tuberculosis

Fungal Infections

Ñ    Candida:

Immunocompromised

Ñ    Histoplasmosis

Ñ    Coccidiomycosis

Mural factors

Surgery

Ñ    Post pericardiotomy

Systemic factors

CVS

Ñ    Post myocardial infarction

KUS

Ñ    Uraemia

LMS

Ñ    Rheumatic fever, SLE, scleroderma

E&M

Ñ    Hypothyroidism

RS

Ñ    Carcinoma of the bronchus

RAG

Ñ    Breast cancer

HS

Ñ    Hodgkin’s disease

Drugs

Ñ    Isoniazid, procainamide, hydralazine, cyclophosphamide, doxorubicin

Pathological Process

Ñ    Inflammation with fibrinous material deposited in the pericardial space

Ñ    Effusion common

Clinical Features

History

CVS

Ñ    Chest pain

Ñ    Sharp, substernal pain

Ñ    Relieved by leaning forward

Ñ    Aggravated by lying down

Ñ    Increased by movement and respiration

Examination

E&M

Ñ    Fever

CVS

Ñ    Tachycardia

Ñ    Pericardial friction rub

Complications

CVS

Ñ    Pericardial effusion

Ñ    Pericardial tamponade

Investigations

Fluids

Blood

Haematology

Ñ    Leucocytosis later lymphocytosis

Ñ    ESR elevated

Biochemistry

Ñ    Cardiac enzymes:

·          Elevated:

If there is an associated myocarditis

Imaging

Chest X-ray 

Ñ    Globular heart:

If there is an effusion

ECHO

Ñ    Demonstrates presence of an effusion

Electrophysiology

ECG

Ñ    ST elevation with a concavity upwards in the leads that face the epicardium:

Anterior, lateral, inferior

Ñ    ST depression in AVR, V₁, V₂:

Cavity leads

Ñ    Later ST segments normalise

Ñ    T inversion develops:

This is lost as the illness improves

T inversion may persist if the patient develops chronic pericarditis

Management

Control

Drugs

Ñ    NSAIDs

Ñ    Steroids

Ñ    Azathioprine

Ñ    Colchicine

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