Pericardial Disease

Pericardial Disease

Acute Pericarditis

Pathology:                     Inflammation of the pericardium, usually lastingless than six weeks duration.            It is the commonest pathology of the pericardium

Aetiology:                      Idiopathic      

Infection: Viral (Coxsackievirus), bacteria (Staphylococcus orStreptococcus),

mycoplasma, fungal,parasitic, Infective endocarditis


Neoplasm: Primary (rhabdomyosarcoma), metastatic (lung orbreast cancer)

Cardiac: Myocarditis, dissecting aortic aneurysm, Dressler’ssyndrome

Trauma: Blunt, penetrating, iatrogenic

Autoimmune: Lupus, rheumatoid arthritis, scleroderma, vasculitis

Drugs: Procainamide, isoniazid, Hydralazine

Metabolic: Hypothyroidism, uraemia, ovarian hyperstimulationsyndrome

Symptoms:     Pleuritic central chest pain (improved onleaning forward or sitting up), fever

Signs: Pericardial rub (scratchingsound best heard over the left sternal edge), signs of cardiac tamponade


Investigations:           Blood:FBC, CRP, ESR

Viral Titres: Acuteand convalescent titres

ECG: Diffuse concave ST elevation with PRdepression

Echo: Assessing structure and function andevidence of pericardial effusion


Treatment:    NSAIDs are first line

Corticosteroids canbe used if NSAID’s contraindicated

Colchicine is usedfor refractory cases


Complications:           Cardiac tamponade or constrictivepericarditis may occur in those with malignancy or tuberculosis. Pericarditismay relapse or pericardial effusion may be present.


Prognosis:      Usually good for viral pericarditis.

15-40%relapse and have a poorer prognosis than the first episode.

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