Pericarditis

Etiology

  • Trauma
  • Idiopathic (often presumed post-viral)
  • 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

  • Sharp
  • Acute
  • Left sided chest pain
  • CP worse w/deep breath
  • CP worse lying down; better sitting up/leaning forward
  • Sometimes SOB, fever, weakness
  • May have myocarditis too, as there's often overlap

Physical Exam Findings

  • Fever
  • May be tachycardic - depending on degree pain/inflammation; also if effusion, depressed ventricular function
  • Often pericardial friction rub present (3 components)
  • If effusion→ may have decreased heart sounds
  • If tamponade→ elevated jvp, soft heart sounds, elevated hr, low bp, pulses paradoxus (more then 10 point difference between SBP on expiration v inspiration), sometimes palpable pulse volume varies

Sub-Diseases

Tests