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
Radiation
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.
