Pericarditis

27/09/2013 by admin | Cardiology

Definition

is an inflammation of the pericardium

Pericarditis can be classified according to the composition of the inflammatory exudate

Types include:

  1. serous – lacking any blood cells/clotting factors
  2. purulent – pus
  3. fibrinous
  4. caseous –cheesy, granulomatous
  5. hemorrhagic – bloody
  6. post infarction

 

Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or heart attack (=dressler’s syndrome: 4-6/52, may be up to 3/12).

One form of chronic pericarditis is constrictive pericarditis.

  1. Clinically:
    1. o Acute (<6 weeks)
    2. o Subacute (6 weeks to 6 months)
    3. o Chronic (>6 months)

 

Incidence

Epidemiology

Presenting complaint

  1. Chest pain, radiating to the back and relieved by sitting up forward and worsened by lying down, is the classical presentation
  2. dry cough
  3. fever
  4. fatigue
  5. anxiety..
  6. Signs:
  7. The classic sign of pericarditis is a friction rub. Other signs include diffuse ST-elevation (‘saddle ST-elevation’) and PR-depression on ECG in all leads except aVR and V1
  8. cardiac tamponade (pulsus paradoxus with hypotension)
  9. congestive heart failure (elevated jugular venous pressure with peripheral edema = RHF picture).

 

Diagnostic tools/investigations

Pericardiocentesis can be performed to permit analysis of the pericardial fluid.

Aetiology

Infective:

In children = coxsackie B-virus

In adults =

  1. CMV
  2. herpesvirus
  3. HIV
  4. Pneumococcus
  5. tuberculous pericarditis= TB in regions where TB is common!! Constrictive pericarditis!!
  1. histoplasmosis
  2. Aspergillus
  3. Candida
  4. Coccidioides
  5. Others…

 

Other causes

  1. Idiopathic (>50% of cases)
  2. Immunologic conditions including SLE (more common among women) or rheumatic fever
  3. Myocardial Infarction (Dressler’s syndrome)
  4. Trauma to the heart, e.g. puncture, resulting in infection or inflammation
  5. Uremia (uremic pericarditis)
  6. Malignancy (as a paraneoplastic phenomenon)
  7. Side effect of some medications, e.g. isoniazid, cyclosporine, hydralazine, tetracyclines
  8. Radiation induced
  9. Aortic dissection
  10. Postpericardiotomy syndrome

 

Pathophysiology

Most acute idiopathic percarditis infections resolve without complication

Hereditary? Infective? How does it spread?

Treatment and management (conservative/medical/surgical)

  1. NSAIDs
  2. antibiotics – specific to causative organism
  3. steroids
  4. colchicine – non-specific anti-inflammatory. 
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