Acute Pricarditis

Definition: Acute inflammation of the pericardium.

Acute pericarditis is a type of pericarditis  (an inflammation of the sac surrounding the heart, the pericardium) usually lasting < 6 weeks. It is by far the most common condition affecting the pericardium.

Acute Pricarditis

Aetiology:

[A] Common:

  1. Acute myocardial infraction.
  2. Viral ( Coxacike-B virus, but often not identified)

[B] Less common:

  1. Malignant disease.
  2. Trauma (e.g. blunt chest injury)
  3. Connective tissue disease (e.g. SLE)

[C] Rare:

  1. Bacterial infection.
  2. Rheumatic fever.

Clinical features:

Symptoms:

  1. Retrosternal chest pain: Radiates to shoulders and neck and is often aggravated by deep breathing, movement, change of position, exercise and swallowing.
  2. Low grade fever.

Signs: Pericardial friction rub: Confirmatory.

High pitched superficial scratching or crunching noise, ‘to-and-fro’ in character best heard in systole over the left 4th space close to the sternum. A rub is often most easily detected by listening both held inspiration & expiration with the stethoscope diaphragm.

Pathophysiology:

Clinical presentation of diseases of pericardium may vary between:

  • Acute and recurrent pericarditis
  • Pericardial effusion without major hemodynamic compromise
  • Cardiac tamponade
  • Constrictive pericarditis
  • Effusive-constrictive pericarditis

Acute pericarditis is characterised by the inflammation of the pericardial sac.

Investigations:

  1. ECG:
  • S-T segment elevation with upward concavity in early cases.
  • PR interval depression is a very sensitive indicator of acute pericarditis.
  • Later, T wave inversion, particularly if there is a degree of myocarditis.
  1. X-ray chest: To exclude lung cancer.
  2. PPD: To exclude tuberculosis.
  3. ANA if SLE is suspected.
  4. Echo: Echo free space (if there is pericardial effusion)

Treatment:

  1. Absolute bed rest.
  2. Anti-inflammatory drugs:

(a)Aspirin 600 mg 4 hourly.

(b)Indomethacin 25 mg 8 hourly (may be required)

  1. Corticosteriods suppress symptoms.

  2. Treatment of the causes.

  3. Purulent pericarditis: requires

(a) Antibiotic therapy.

(b) Surgical drainage (if necessary)

Reference:

  1. Davidson’s Principles and Practice of Medicine, 21st
  2. Wikipedia free encyclopedia.

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