Overview

• Pericarditis → inflammation of the pericardium (outer sac) that may be acute or chronic
• Acute → new-onset inflammation lasting <4 to 6 weeks. Most commonly caused by a viral infection.
• M>F (3:1), most common in 20-50 yr olds
• Risk Factors/Causes → male, age 20-50, idiopathic, transmural myocardial infarction, cardiac surgery, neoplasm, reecent viral and bacterial infections (coxsackie B virus), uraemia/on dialysis, systemic autoimmune disorders (RA, SLE)
• Chronic Pericarditis → lasts >3 months. Leads to constrictive pericarditis (raised JVP).
  • Constrictive Pericarditis ⇒ dyspnoea, right heart failure (peripheral oedema), raised JVP, positive kussmaul’s sign (paradoxical rise in JVP on inspiration), pulsus paradoxus (large drop in BP during inspiration - sign of tamponade). CXR may show pericardial calcification.
  • Kussmaul’s Sign = differentiates constrictive pericarditis and cardiac tamponade.

(Dressler’s Syndrome ⇒ pericarditis several weeks after an MI)

Making Diagnosis

Clinical Features:

• Chest Pain → acute in onset, sharp & pleuritic. May be stabbing or aching. Relieved when sitting up or leaning forwards (hence also worse when lying down). Can radiate to neck and shoulders (typically left side)
• Pericardial Rub → occurs in 1/3 of cases. Superficial scratchy or squeaking sound best heard with the diaphragm of the stethoscope over the left sternal border. Heard best at the left sternal edge with the patient leaning forward at end-expiration.
• May also have fever & myalgia
• Cardiac Tamponade ⇒ Beck’s Triad = raised JVP, decreased BP, muffled heart sounds
  • Pulsus Paradoxus → abnormally large drop in BP during inspiration

Investigations:

• ECG → saddle shaped ST elevation (IN ALL LEADS) + PR depression
  • Pericarditis ECG
• Transthoracic Echocardiography → pericardial effusion (cardiac tamponade) may be present