is an inflammation of the pericardium
Pericarditis can be classified according to the composition of the inflammatory exudate
- serous – lacking any blood cells/clotting factors
- purulent – pus
- caseous –cheesy, granulomatous
- hemorrhagic – bloody
- 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.
- o Acute (<6 weeks)
- o Subacute (6 weeks to 6 months)
- o Chronic (>6 months)
- Chest pain, radiating to the back and relieved by sitting up forward and worsened by lying down, is the classical presentation
- dry cough
- 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
- cardiac tamponade (pulsus paradoxus with hypotension)
- congestive heart failure (elevated jugular venous pressure with peripheral edema = RHF picture).
Pericardiocentesis can be performed to permit analysis of the pericardial fluid.
In children = coxsackie B-virus
In adults =
- tuberculous pericarditis= TB in regions where TB is common!! Constrictive pericarditis!!
- Idiopathic (>50% of cases)
- Immunologic conditions including SLE (more common among women) or rheumatic fever
- Myocardial Infarction (Dressler’s syndrome)
- Trauma to the heart, e.g. puncture, resulting in infection or inflammation
- Uremia (uremic pericarditis)
- Malignancy (as a paraneoplastic phenomenon)
- Side effect of some medications, e.g. isoniazid, cyclosporine, hydralazine, tetracyclines
- Radiation induced
- Aortic dissection
- Postpericardiotomy syndrome
Most acute idiopathic percarditis infections resolve without complication
Hereditary? Infective? How does it spread?
Treatment and management (conservative/medical/surgical)
- antibiotics – specific to causative organism
- colchicine – non-specific anti-inflammatory.