Pericarditis
| Headline | |
|---|---|
| Etiology | Infective (viral, pneumonia, rheumatic fever), MI (Dressler's syndrome), drugs (procainamide, penicillin, isoniazid, hydralazine), trauma, uraemia/dialysis-associated, SLE, Rheumatoid arthritis, myxoedema, surgery, malignancy, radiotherapy, sarcoidosis... > Time course: 4-6 weeks. |
| epidemiology | M>F 3:1 |
| Clinical presentation | Chest pain worse on inspiration/lying flat, relieved by sitting forward, ±fever ↑ JVP on inspiration (Kussmaul’s sign = constrictive pericarditis), ±↑ troponin, ↑ inflammatory markers |
| Pathogenesis | |
| Diagnostic investigations | Clinical diagnosis. ECG: concave global ST elevation, PR depression CXR: ± effusion. Pericardiocentesis is diagnostic Complications: cardiac tamponade |
| Management | ➥ NSAID for symptom management + PPI (colchicine if NSAIDs contraindicated) ➥ colchicine + steroids 2nd line ➥➥ colchicine = improves response, ↓ recurrence ➥ If purulent: vancomycin + ceftriaxone/gentamicin ➥ pericardiocentesis ➥ Exercise restriction until s/s resolved |