IntroductionAcute pericarditis is inflammation of the pericardium. Classically, fibrinous material is deposited into the pericardial space and pericardial effusions commonly occur.
CausesThe commonest cause is viral infection.
- Viral: coxsackie B, echovirus. Usually painful but short-term
- Post-MI: occurs in 20% of patients in the first few fays after myocardial infarction. May also occur later in Dressler’s syndrome
- Uraemic: due to irritation by accumulating toxins
- Malignant: usually produces a haemorrhagic effusion. Usually from bronchial cancer, breast cancer and Hodgkin’s lymphoma.
- Connective tissue disorders e.g. Rheumatoid arthritis, systemic lupus erythematosus
- Bacterial: can occur in septicaemia and post-operatively
- Fungal e.g. histoplasmosis
SymptomsChest pain with the following characteristics:
Site: central, well-localised
Radiation: left shoulder, left arm, abdomen
Exacerbating factors: Breathing, movement, lying down
Relieving factors: Leaning forwards
- Pericardial rub: usually heard at the left sternal edge during systole
- Signs of right ventricular failure e.g. oedema, Kussmaul’s sign (rise of JVP on inspiration)
- Pulsus paradoxus
- ECG: diagnostic. Shows saddle-shaped ST elevation in all leads without ST depression. May also show T wave inversion and PR depression
- Chest x-ray: may show globular cardiac enlargement
- Echocardiography: confirms pericardial effusion
ManagementTreat the underlying cause. Viral causes recover within a few days-weeks. Consider:
- Analgesia: NSAIDs e.g. diclofenac
- Pericardiocentesis: for large, complicated effusions. May also be used for diagnostic purposes
PrognosisGood. However, 20% of cases go on to develop idiopathic relapsing pericarditis.