Pericarditis (overview)

Sites

  • Inflammation of the pericardium

Etiology

  • Trauma
  • Idiopathic
  • Infection: Viral most common--> Coxsackie, HSV, HIV; Bacterial (extension from pneumonia); TB (miliary or extension from pneumonia), Acute Rheumatic Fever
  • Autoimmune: Lupus, Rheumatoid Arthritis, Scleroderma, Mixed Connective Tissue d/o, Stills Disease
  • Toxic/Metabolic: Uremia, hypothyroidism
  • Meds: Hydralazine, procainamide, phenytoin, isoniazid, penicillins, others
  • Radiation or cancer involving the mediastinum
  • Post MI (early or late)
  • Post cardiac surgery

Symptoms

  • Spectrum of sx including acute, sharp, left sided chest pain
  • Worse w/deep breath, lying down. Better sitting up/leaning forward
  • Sometimes SOB, weakness, fever

Physical Exam Findings

  • May be tachycardic - depending on degree pain/inflammation; also if effusion, depressed ventricular function
  • Pericardial friction rub (three components)
  • If effusion, may have decreased heart sounds
  • If tamponade, elevated jvp, soft heart sounds, elevated hr, low bp, pulsus paradoxus (more then 10 point difference between SBP on expiration v inspiration), sometime palpable pulse volume varies

Tests