Acute Pericarditis

Pericarditis

Blog written by – Dr Andrew Lam

High-Risk Features that May Require Admission:

Fever > 38°C
The sub-Acute course of symptoms, progressing over several days to weeks
Evidence of cardiac tamponade
Moderate to large pericardial effusion
Immunosuppression
Failure to improve despite initial medical therapy with NSAID’s and colchicine
Elevated troponin (suggestive of perimyocarditis)

ECG Findings in Acute Pericarditis                                                                                       

Acute Pericarditis – Widespread concave ST elevation (V2-6) and (I, II, aVL, aVF)

Aetiology of Pericarditis

Indeterminate: Assumed to be of viral or immune origin
Infectious:
Viral – Coxsackie, echovirus, adenovirus, EBV, CMV, influenza, HIV
Bacterial – M. Tuberculosis, Staphylococcus, Streptococcus, Haemophilus, Salmonella, Chlamydia
Fungal – Histoplasmosis, Aspergillus
Parasitic – Echinococcus, Toxoplasma, Amoebic
Malignant: Metastatic breast or lung cancer, melanoma, leukemia, lymphoma.
Cardiac: Post-infarction, Dressler’s syndrome
Metabolic: Uraemia
Radiotherapy
Drug-Induced (rare): Isoniazid, hydralazine, anticoagulants, thrombolytics, phenytoin, penicillins

References:

Burns, E., Buttner, R. (2021). Pericarditis. Life in the Fastlane. Retrieved 5th July 2021 from https://litfl.com/pericarditis-ecg-library/

Hoit, B.D. (2021) Etiology of pericardial disease. UpToDate. Retrieved 5th July 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/etiology-of-pericardial-disease

Imazio, M. (2021) Acute pericarditis: Clinical presentation, diagnostic evaluation and diagnosis. UpToDate. Retrieved 5th July 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/acute-pericarditis-clinical-presentation-diagnostic-evaluation-and-diagnosis