Pericarditis

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Inflammation of the heart membrane (pericardium), which may be:

• Acute and self-limiting, sub-acute or chronic
• Fibrinous, serous, haemorrhagic or purulent

Causes

• Idiopathic or viral (most common causes) g. Coxsackie A & B, influenza A & B, varicella
• Bacterial e.g. mycobacterium, staphylococcus, meningococcus, streptococcus, pneumococcus, gonococcus, mycoplasma
• Fungal: Histoplasmosis
• Severe kidney failure (less common)
• Hypersensitivity such as acute rheumatic fever
• Myocardial infarction
• Radiation, trauma, neoplasms

Clinical Features

• Pericarditis without effusion: retrosternal pain radiating to shoulder, which worsens on deep breathing, movement, change of position or exercise; pericardial rub is a diagnostic sign
• Pericardial effusion: reduced cardiac impulses, muffled heart sounds, cardiomegaly
• Cardiac tamponade (compression) in case of massive effusion or constrictive pericarditis: dyspnoea, restlessness, rising pulmonary and systemic venous pressure, rapid heart rate, pulsus paradoxus, low BP, and low output cardiac failure

Differential diagnosis

• Other causes of chest pain
• Other cause of heart failure

Investigations

• ECG, chest X-ray
• Echo-cardiography

Management

Treatment

If viral or idiopathic

• Rest
• Ibuprofen 600 mg every 8 hours
• If there is fluid, perform tapping

If other causes, treat accordingly

Prevention

• Early detection and treatment of potential (treatable) causes