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 myocardial infraction.
- Viral ( Coxacike-B virus, but often not identified)
[B] Less common:
- Malignant disease.
- Trauma (e.g. blunt chest injury)
- Connective tissue disease (e.g. SLE)
- Bacterial infection.
- Rheumatic fever.
- Retrosternal chest pain: Radiates to shoulders and neck and is often aggravated by deep breathing, movement, change of position, exercise and swallowing.
- 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.
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.
- 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.
- X-ray chest: To exclude lung cancer.
- PPD: To exclude tuberculosis.
- ANA if SLE is suspected.
- Echo: Echo free space (if there is pericardial effusion)
- Absolute bed rest.
- Anti-inflammatory drugs:
(a)Aspirin 600 mg 4 hourly.
(b)Indomethacin 25 mg 8 hourly (may be required)
- Corticosteriods suppress symptoms.
Treatment of the causes.
Purulent pericarditis: requires
(a) Antibiotic therapy.
(b) Surgical drainage (if necessary)
- Davidson’s Principles and Practice of Medicine, 21st
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