Pericarditis

What is the definition of pericarditis?

Inflammation of the pericardial sac causing chest pain, friction rub, and characteristic ECG changes.

What is the most common cause of acute pericarditis?

Viral infection (Coxsackievirus, echovirus, adenovirus)

What infectious causes can lead to pericarditis?

• Viral (most common)

• Bacterial

• Tuberculosis

• Fungal

What non-infectious causes can lead to pericarditis?

• Autoimmune disease

• Post-MI (Dressler syndrome)

• Uremia

• Malignancy

• Radiation

• Trauma

• Drug-induced

What autoimmune diseases are associated with pericarditis?

• SLE

• Rheumatoid arthritis

• Sarcoidosis

What is the pathophysiology of pericarditis?

Inflammation of the pericardium → increased vascular permeability → pericardial fluid accumulation → chest pain and possible effusion.

What causes chest pain in pericarditis?

Inflamed pericardial layers rub against each other, producing sharp, pleuritic pain.

What are classic symptoms of pericarditis?

• Sharp chest pain

• Pain worse with inspiration

• Pain relieved by sitting forward

• Fever

• Dyspnea

What physical exam finding is characteristic of pericarditis?

Pericardial friction rub

What are common ECG findings in acute pericarditis?

• Diffuse ST elevation

• PR depression

• T-wave inversion (later)

What laboratory findings support pericarditis?

• Elevated ESR

• Elevated CRP

• Elevated troponin (if myocardium involved)

Why can troponin be elevated in pericarditis?

Inflammation may extend into the myocardium (myopericarditis).

What imaging study is most useful for evaluating pericarditis?

Echocardiogram

What echocardiogram findings suggest pericarditis?

• Pericardial effusion

• Normal ventricular function (unless myopericarditis)

What is the most serious complication of pericarditis?

Cardiac tamponade

What are signs of cardiac tamponade?

• Hypotension

• JVD

• Muffled heart sounds (Beck’s triad)

What is pulsus paradoxus?

A drop in systolic BP >10 mmHg during inspiration, seen in tamponade.

What is the first-line treatment for acute pericarditis?

NSAIDs + colchicine

What is the role of colchicine in pericarditis?

Reduces recurrence and inflammation.

When are corticosteroids used in pericarditis?

Autoimmune disease, refractory cases, or contraindication to NSAIDs.

What medications should be avoided after MI-related pericarditis?

NSAIDs (except aspirin) because they may impair myocardial healing.

What lifestyle modifications are recommended for pericarditis?

• Avoid strenuous activity

• Treat underlying cause

• Gradual return to exercise after symptom resolution

What are major complications of pericarditis?

• Cardiac tamponade

• Constrictive pericarditis

• Recurrent pericarditis

What is constrictive pericarditis?

Chronic scarring and thickening of the pericardium causing impaired ventricular filling.

What is Dressler syndrome?

Autoimmune pericarditis occurring weeks after MI.

What is the classic chest pain description in pericarditis?

Sharp, pleuritic pain relieved by sitting forward.

What is the most important ECG finding in pericarditis?

Diffuse ST elevation

What conditions can mimic pericarditis?

• Acute coronary syndrome

• Myocarditis

• PE

• Pneumonia

• GERD

What condition most closely mimics pericarditis chest pain?

Acute coronary syndrome