Pericarditis



Aetiology

Infections

  • Coxsackie, bacterial, TB

Neoplastic

Drugs

  • Procainamide, Hydralazine

Autoimmune

Approach


Diagnosis

Acute pericarditis is an inflammatory pericardial syndrome with or without pericardial effusion.

The clinical diagnosis can be made with two of the 4 criteria:

  1. Pericarditic chest pain (pleuritic, eased by siting up) [90% of cases]
  2. Pericardial rub [30%]
  3. New widespread ST-elevation or PR depression [60%]
  4. Pericardial effusion (new or worsening)[60%]

Inflam. markers may be raised.

CXR usually normal (unless effusion).

TnI may be raise if concomitant myocarditis.

ECG

  • Diffuse concave ST elevation (ST depression in V1)
  • Low voltage if effusion
  • Later flattening or inversion T globally
  • Return to normal(3/12)
Pericarditis

Treatment

  • Aspirin (750-1000mg every 8hrs) plus PPI for 2 weeks
    or
  • Ibuprofen (600mg every 8 hours) plus PPI for 2 weeks
    plus
  • Colchicine 0.5mg once (<70kg) or 0.5mg bd (≥70kg) for up to 3 months
  • Refer cardiology if cardiac compromise or recurrent


Content by Dr Íomhar O' Sullivan 22/02/2005. Reviewed by Dr ÍOS 26/04/2007. Last review Dr ÍOS 10/06/21