Podcast #108: Pericarditis

heart-56e714793df78c5ba0576bb7Run Time: 4 minutes

Author:  Gretchen Hinson M.D.

Educational Pearls:

  • The pericardium has a visceral and pericardial reflection, between which there is a potential space with between 15-50 mL of serous fluid lubricating that space allowing for friction-free movement of the heart.
  • Inflammation of this space is called pericarditis. The most common cause of pericarditis are idiopathic or viral, often following a viral or respiratory illness.  But can also be caused by uremia (in renal failure patients), autoimmune diseases,  after myocardial infarction (Dressler’s Syndrome), post radiation, related to cancer and with infections like TB or Malaria.
  • Infectious pericarditis, consisting of purulent fluid in the pericardial sack, causes high fever and sepsis presentation and these patients are usually very ill-appearing.
  • Some of the common symptoms of pericarditis are inflammation in the chest represented by sharp, pleuritic chest pain that is improved by leaning forward, a waxing and waning friction rub or squeaking sounds when listening over the left sternal border, and less frequently findings of cardiac tamponade when effusions are either very large or accumulate very quickly.
  • 60% of patients within the first 24 hours of developing pericarditis will have classic EKG findings of pericarditis consisting of ST segment elevation diffusely with concave upwards and PR depression with a P to T segment acting as baseline. After a few days of pericarditis, patients often have pseudo-normal findings on an EKG. Past a few days, patients can have T-wave inversion, which either persist or re-normalize over time.
  • Unless you have myopericarditis, a troponin will not be elevated with pericarditis.
  • Treatment is specific to the causal agent of the inflammation, meaning that for viral or idiopathic causes pericarditis will resolve with time and must be treated supportively. Anti-inflammatories such as Indomethicin, Prednisone and Colchicine are often used – but consultation with a cardiologist is often necessary to guide treatment and followup.

Link to Podcast: http://medicalminute.madewithopinion.com/pericarditis-1/

References: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878263/

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