Pericarditis

Inflammation of the pericardium

Aetiology

Infectious causes

  • Viral (most common): Coxsackievirus, echovirus, adenovirus, influenza
  • Bacterial: Mycobacterium tuberculosis, Staphylococcus, Streptococcus
  • Fungal or parasitic (rare)

Non-infectious causes

  • Autoimmune and inflammatory diseases (e.g., SLE, rheumatoid arthritis)
  • Post–myocardial infarction (early post-MI or Dressler syndrome)
  • Post-cardiac surgery or trauma
  • Malignancy
  • Uremia
  • Radiation therapy
  • Drug-induced
Idiopathic pericarditis
  • Presumed viral or immune-mediated in origin

Clinical presentation

  • Chest pain
    • Sharp, pleuritic
    • Worsened by inspiration and supine position
    • Relieved by sitting forward
  • Dyspnea
  • Low-grade fever
  • Palpitations
  • Pericardial friction rub
    • High-pitched, scratchy sound
    • Best heard at left sternal border

Investigations

ECG

  • Diffuse ST-segment elevation (concave upward)
  • PR-segment depression
  • Lack of reciprocal ST depression (except in aVR, V1)
  • ECG changes evolve through four classical stages

Management

  • Virus → Supportive - NSAIDs for 1-2 weeks
    • Ibuprofen 400-600 mg/6-8 hr/IV + Colchicine 0.5-0.6 mg 3-4x/day PO

Complications

  • Pericardial effusion
  • Tamponade
  • Constrictive pericarditis
  • Cardiac failure
  • Death