Pericarditis

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Introduction

An inflammation of the pericardium, which may arise from viral, bacterial, fungal or protozoal infections

Other causes: metabolic, malignancy, connective tissue disease, radiation, trauma etc

May be acute or chronic

Clinical Features

Acute pericarditis:

• Chest pain
  • Retrosternal
  • Sharp
  • Radiating to the left shoulder
  • Made worse by breathing or coughing
  • Relieved by the upright position
• Low-grade fever
• Pericardial friction rub

Chronic pericarditis:

• Insidious onset
  • Dyspnoea on exertion
  • Leg and abdominal swelling

Differential Diagnoses

• Endomyocardial fibrosis
• Sarcoidosis
• Amyloidosis

 

Complications

• Pericardial tamponade
• Constrictive pericarditis

Investigations

• Electrocardiography
• FBC and differentials
• Chest radiograph
• Echocardiography

Treatment Goals

• Relieve distress from pain and tamponade
• Relieve constriction
• Treat the effect on the heart
• Treat complications
• Eradicate the organism (if cause is infection)

Non-drug Treatment

• Bed rest

Drug Treatment

• NSAIDs
  • Indomethacin 50 mg orally every 8 hours

Or:

• Ibuprofen 400 - 800 mg orally every 12 hours
• Steroids

-     Prednisolone 30 mg orally every 8 hours and tapered

• Anti-tuberculous drugs or other antimicrobial agents (if mycobacterium or other microbes are causative)

Supportive Measures

• Pericardiocentesis
• Pericardiectomy

Notable Adverse Drug

Reactions, Contraindications and Caution NSAIDs/steroids: dyspepsia and upper GI bleeding

Prevention

• Avoid radiation
• Prevent infection