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Thursday April 26th, 2012 • *Inflammatory condition that can arise from a wide variety of causes: •Infection •Autoimmune •JIA, SLE •Rheumatic fever •Uremia •Malignancy •Reaction to a drug •Post cardiac surgery •Idiopathic (30%) Most common cause Prodrome of respiratory or GI illness Coxackievirus Echovirus Adenovirus EBV Influenza HIV Presentation = fever, chest pain, friction rub Often accompanied by myocarditis Less common, but higher mortality Staph aureus Haemophilus influenzae Presentation = toxic appearance, high temp, irritable, chest pain, cardiomegaly May be post-op or from another site (PNA) TB pericarditis Spread from lymph nodes or blood borne Large effusions and cardiac tamponade common Chest pain tends to be substernal, sharp, worse with inspiration and relieved by sitting upright and leaning forward Radiates to scapular ridge Pericardial friction rub Scratchy, high-pitched to-and-fro sound Heard best in 2nd and 4th intercostal space at LSB midclavicular line Elevated WBC, ESR, and CRP Troponin may be increased Blood cx, viral cx, TB skin testing, gastric cultures for Mycobacterium, RF, and ANA may be helpful ECG most useful diagnostic test A 15-year-old patient is brought to your office with the complaint of chest pain. She had been healthy until 3 days ago, when she developed a fever. The pain is percordial, referred to the epigastrum, and exacerbated by deep breathing and coughing. She refuses to lie down and prefers to sit leaning forward. Of the following, the MOST likely expected finding on ECG is: A. elevation of S-T segment B. first-degree heart block C. pre-excitation with a delta wave D. tall peaked T waves E. T-wave flattening 4 stages 1. Diffuse ST segment elevation and PR segment depression 2. Normalization of the ST and PR segments 3. Development of widespread T-wave inversions 4. Normalization of the T-waves If effusion is present → low-voltage QRS If cardiac tamponade → electrical alternans Usually normal If effusion present, then triangular shaped heart with smooth border “Water-bottle” heart May be normal May reveal effusion Absence of effusion does not exclude pericarditis Treat the underlying cause NSAIDS = to alleviate chest pain If chest pain persists beyond 2 weeks, colchicine can be added Steroids = reserved for those unresponsive to NSAIDS and colchicine or with a rheumatologic or recurrent disease Pericardiocentesis = indicated with hemodynamic compromise, cardiac tamponade, purulent pericarditis, and suspected neoplastic pericarditis Resistant cases→ pericardial window or pericardiectomy Recurrence (30%) Constrictive pericarditis Cardiac tamponade Noon Conference with Lunch
