Pericarditis
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This is an inflammation of the pericardium; may be acute or chronic.
Causes
- Infectious and non-infectious pericarditis
- Tuberculous Pericarditis is a common cause for Pericarditis in the black race
- Viral, bacterial, fungal or protozoal infections
- Other causes: metabolic, malignancy, connective tissue disease, radiation, trauma etc.
Signs and symptoms
Acute pericarditis:
- Chest pain: not always present; sharp, retrosternal, often severe and pleuritic, radiating to the left shoulder, made worse by breathing or coughing, aggravated by lying supine but relieved by sitting up and leaning forward.
- Fever: low grade
- Pericardial friction rub: best heard during expiration with patient sitting up, and stethoscope placed firmly against the chest
Chronic pericarditis:
Insidious onset
There may be:
- Dyspnoea on exertion
- Leg and abdominal swelling
Differential diagnosis
- Endomyocardial fibrosis
- Sarcoidosis
- Amyloidosis
Investigations
- Electrocardiography
- Full blood count and differentials
- Chest radiograph
- Echocardiography
- Investigate for Tuberculosis
- ESR and CRP
- Pericardial fluid analysis if significant effusion present
Treatment objectives
- Relieve distress from pain and tamponade
- Relieve constriction
- Treat the effect on the heart
- Treat complications
- Eradicate the organism (if cause is infection)
Non-pharmacological treatment
- Bed rest
Pharmacological treatment
NSAIMs (mainstay of treatment)
Indomethacin oral
50 mg orally every 8 hours
OR
Ibuprofen oral
400-800 mg orally every 12 hours
Steroids:
Prednisolone oral
30 mg orally every 8 hours and tapered
Anti-tuberculous drugs or other antimicrobial agents (if mycobacterium or other microbes are causative)
Prevention
- Avoid radiation
- Prevent infection