Pericarditis

Exam Cram

• Pericardium is the connective tissue surrounding the heart

• Pericarditis types: acute or chronic (constrictive)

• Acute pericarditis presents with pleurisy better leaning forward and concave/ saddle ST elevation

• Acute pericarditis management: NSAIDs

Diseases of the Pericardium

• Pericarditis

  • Acute pericarditis

  • Constrictive (chronic)

• Pericardial effusion

  • Pericardial tamponade

Acute Pericarditis

Background 

• Pericarditis describes inflammation of the pericardium, the connective tissue surrounding the heart

Assessment

History:

• Recent viral infection

• Pleuritic chest pain, better leaning forward

• Sob, mild feverish

Examination:

• Pericardial rub

• Tachycardia

Investigations

• ECG: 

  • • • ST elevation: saddle shaped, concave- widespread

      • PR depression

      • T wave flattening (later sign)

• Raised troponin

• Raised CRP

Diagnosis

Diagnostic criteria: 2/4 (European College of Cardiology)

• Chest pain

• Pericardial rub

• Pericarditis ECG changes

• Pericardial effusion

Differentials: NSTEMI , Pulmonary Embolus, Pneumomia 

Aetiology: 

1. Idiopathic (primary)

2. Secondary

   1. Viruses: coxsackie B, Influenza 

   2. Post MI: Dressler's syndrome

   3. Inflammatory conditions

   4. Hyperureamia: CKD

Management

1. 1. 1. NSAIDS & paracetamol

      2. Consider colcichine or prednisolone

      3. IL-1 inhibitors: anikara/ canalizumab

Colcichine- treats acute pericarditis but also reduces chance of future episodes, advised 6m course

Nil NSAIDs in post MI pericarditis due to preventing recovery. 

Complications

• Pericardial Effusion & Tamponade 

Constrictive Pericarditis

Background

• Complication of acute pericarditis causing the pericardium to loose its elasticity causing diasytolic dysfunction, usually a chronic irreversible process

• Results in HFpEF

Assessment

History

• 1yr gradual sob, fatigue

Examination

• Hepatomegaly and later ascites

• Pericardial knock 50%

• Pleural effusion

Investigations

• ECHO- diastolic dysfunction

Diagnosis

Diagnostic criteria: ECHO findings

Classification (aetiology):

• Complication of pericarditis or tamponade 

• Systemic conditions: amyloidosis, SLE, Rheumatoid Arthritis

• Tuberculosis

  • Commonest cause worldwide

  • Pericardial fluid: lymphocytosis

Management

• Treat underlying cause

• As per HFpEF

Definitions

Pericardial Diseases

• Pericarditis- acute reversible damage to pericardium

• Constrictive pericarditis- chronic irreversible changes

• Pericardial effusion and tamponade- fluid in pericardial space

Myocardial Diseases

Myocarditis- acute reversible damage to myocardium

Cardiomyopathy Phenotypes- long term irreversible damage to cardiac myocardium. 

• Dilated

• Restrictive

• Hypertrophic: HOCM

• Takotsubo Cardiomyopathy 

Endocardial Diseases

• Infective endocariditis

• Non infective endocarditis

Resources and References

1. Yadav NK, Siddique MS. Constrictive Pericarditis. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459314/

Links

• Speciatly: cardiology

Page written in 2024.