Pericarditis

Pathophysiology

inflammation of the pericardium of greater than 6 weeks duration

Signs and Symptoms

1) retrosternal chest pain (classically described as improved with sitting up position and leaning forward and worse by lying flat) 2) chest pain referred to back and lateral trapezius 3) fever 4) friction rub – high pitched and scratching quality (best heard in sitting position during expiration) 5) pleuritic pain 6) pneumonitis 7) pericardial effusion and possible cardiac tamponade 8) positive Ewart’s sign

Characteristic Test Findings

Echocardiogram – 1) best test for diagnosis Radiology – 2) enlarged cardiac silhouette “water bottle” EKG – 3) ST segment elevation in leads V2-V6 4) inverted T waves after ST segments return to normal Laboratory – 5) increase in CK

Associated Conditions

1) infectious – HIV, coxsackie, hepatitis, pneumococcus, Strep, Staph, Legionella, TB 2) drugs – procainamide, hydralazine, phenytoin 3) trauma 4) autoimmune – lupus, sarcoid, scleroderma 5) Dressler’s syndrome 6) postradiation 7) uremia

Treatment

1) bed rest 2) aspirin 3) NSAIDs 4) occasionally steroids 5) pericardiocentesis if tamponade threatens

Tips for USMLE

1) Ewart’s sign is dullness beneath angle of left scapula 2) Dressler’s syndrome is pericarditis after MI 3) if chest pain and fever occur 10 days after a cold, think pericarditis Distinguish MI and pericarditis – 4) both with ST segment elevations and T wave inversion – in pericarditis, T waves invert after ST is normal; in MI, T waves invert during ST elevation 5) no changes in QRS in pericarditis