Back to Basics: Acute Pericarditis

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June 6, 2017 by jtreb

By: Josh Trebach


What:

-Inflammation of the pericardium, the fibrous sac that contains the heart

 

Why:

-Up to 5% of ED visits for chest pain may be related to pericarditis

-Recognition of the disease is important because it can lead to devastating pathology such as cardiac tamponade or constrictive pericarditis

-May also be a clue to other pathology (malignancy, etc.)

 

How: 

-Idiopathic

-Viruses (Coxsackie virus, HIV)

-Bacteria (Staph, Strep, TB)

-Fungal (Histoplasma)

-Malignancy/Metastatic Disease

-Drugs (Procainamide, Hydralazine)

-Uremia

-Radiation

-Connective Tissue Disease

-Autoimmune

-Post-MI, Aortic Dissection

-Myxedema

 

Clinical Features: 

-Chest pain that radiates to back/neck/left shoulder

-Pain may get worse with movement, inspiration, laying supine

-Classic “tripoding” position to relieve discomfort (sitting up and leaning forward)

-Can be associated with fever and shortness of breath

-Friction rub on auscultation

 

Diagnosis: 

-History and Physical

-Classically “diffuse ST elevations” with PR depression

-Serial EKGs are useful to determine new (pathological) from normal (baseline)

-Chest x-ray may show enlarged cardiac silhouette

-Echocardiogram is particularly useful to determine the presence of pericardial effusion

-CBC/BUN/Cr/Thyroid studies/ESR/CK/Troponin

 

pericarditis

 

Treatment:

-Viral or idiopathic etiologies –> Ibuprofen or Colchicine

-Myocarditis, Uremia, Any Hemodynamics Instability, Enlarged cardiac silhouette of unclear etiology –> Admit is likely warranted

 

 

References:

  1. Tintinalli, J. E., & Stapczynski, J. S. (2010). Tintinalli’s emergency medicine: A comprehensive study guide. New York: McGraw-Hill.
  2. Tingle L, Molina D, & Calvert C. Acute Pericarditis. Am Fam Physician.2007 Nov 15;76(10):1509-1514. http://www.aafp.org/afp/2007/1115/p1509.html
  3. EKG provided from https://lifeinthefastlane.com/ecg-library/basics/pericarditis/

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