Pericarditis

What is pericarditis?

Inflammation of the pericardium causing chest pain and possible pericardial effusion/tamponade.

What is the most common cause of pericarditis?

Viral infection.

What is the classic chest pain in pericarditis?

Sharp, pleuritic, stabbing chest pain.

How is pericarditis chest pain different from ACS?

Pericarditis pain is sharp, worse on inspiration/lying flat, relieved by leaning forward.

What position often relieves pericarditis pain?

Sitting upright or leaning forward.

What position makes pericarditis worse?

Lying flat (supine).

What are common symptoms of pericarditis?

Sharp chest pain, dyspnoea, fever, fatigue, recent viral illness.

What are common signs of pericarditis?

Tachycardia, tachypnoea, distress, low-grade fever.

What ECG finding may occur in pericarditis?

Diffuse ST elevation.

Why can pericarditis be mistaken for STEMI?

It may present with chest pain and ST elevation on ECG.

What is the first management approach in QAS?

DRABCDE.

What are the first paramedic actions for suspected pericarditis?

Monitor, 12-lead ECG, observations, position of comfort, assess pain, transport.

Why perform a 12-lead ECG in pericarditis?

To assess for STEMI/ACS mimic and monitor abnormalities.

Does ST elevation always mean STEMI?

No, pericarditis may cause diffuse ST elevation.

What position should a patient with pericarditis be placed in?

Position of comfort, usually sitting upright/leaning forward.

Why sit the patient forward?

Helps reduce pericardial irritation and pain.

When should oxygen be given in pericarditis?

Only if clinically indicated (hypoxia/respiratory distress).

Should oxygen be given routinely?

No.

What analgesia principle applies in QAS?

Follow QAS pain management/analgesia protocol according to clinician scope.

Why is analgesia important in pericarditis?

Reduces pain and distress.

What should be monitored after opioid analgesia?

Sedation, respiratory depression, hypotension.

What monitoring is required in suspected pericarditis?

Cardiac monitoring, serial vital signs, pain assessment, ECG.

What vital sign changes may occur in pericarditis?

Tachycardia, tachypnoea, mild fever.

What is the biggest life-threatening complication of pericarditis?

Cardiac tamponade.

What is cardiac tamponade?

Fluid compressing the heart causing impaired filling and shock.

What are red flags for tamponade?

Hypotension, raised JVP, muffled heart sounds, shock, deterioration.

What is Beck's triad?

Hypotension, raised JVP, muffled heart sounds.

What should you suspect if chest pain + hypotension + raised JVP occurs?

Cardiac tamponade.

What type of shock occurs in cardiac tamponade?

Obstructive shock.

What are signs of poor perfusion in tamponade?

Pale, clammy skin, hypotension, altered LOC, weak pulses.

What is the QAS treatment summary for suspected pericarditis?

DRABCDE → monitor → 12-lead ECG → position upright → analgesia → oxygen if indicated → serial observations → transport.

When should CCP/advanced support be considered?

Haemodynamic instability, suspected tamponade, shock, respiratory compromise, deterioration.

What transport priority is needed for unstable pericarditis/tamponade?

Urgent transport and pre-notification if deteriorating.

What is a common clinical trap in pericarditis?

Assuming STEMI/ACS without considering pericarditis.

How is ACS pain usually described?

Pressure, tightness, heaviness.

How is pericarditis pain usually described?

Sharp, pleuritic, positional.

What feature strongly suggests pericarditis over ACS?

Pain relieved by leaning forward and worse lying flat.

What are common differential diagnoses for pericarditis?

ACS, STEMI, pulmonary embolism, pleurisy, costochondritis, tamponade.

How can costochondritis be differentiated?

Chest pain reproducible on palpation.

How can pulmonary embolism differ from pericarditis?

PE often causes hypoxia, tachypnoea, pleuritic pain and VTE risk factors.

Why is pericarditis potentially time critical?

Risk of cardiac tamponade and obstructive shock.

What is a memory trick for pericarditis?

POSITION = Pain worse lying flat, better sitting forward.

What is a one-line exam recall for pericarditis?

Sharp pleuritic chest pain worse lying flat and relieved leaning forward = think pericarditis.