Pericarditis

Pericarditis refers to inflammation of the pericardium. It can be acute, recurrent, or chronic. It often leads to formation of a pericardial effusion.

Etiology

There are many possible causes of pericarditis, but the most common are viral and autoimmune.

• Infectious
  • Viral (coxsackie, others)
  • Bacterial
• Non-infectious
  • Autoimmune (SLE, Sjögren, RA, +++)
  • Metastasis
  • Metabolic disorder

Classification

• Exudative pericarditis – causes pleural effusion
• Fibrinous pericarditis – does not cause effusion

Clinical features

There’s a typical form of chest pain in acute pericarditis, described as a sharp pain in the retrosternum which worsens on inspiration. The pain improves when leaning forward. Other symptoms include fever and dyspnoea.

A pericardial friction rub on auscultation is typical, which sounds like high-pitched scratching. It’s best heard over the left sternal border. If there’s a large pericardial effusion, heart sounds may be distant.

Diagnosis and evaluation

The diagnosis is based on typical clinical features and findings on ECG, echo, and imaging.

• X-ray – enlarged cardiac silhouette due to pericardial effusion
• ECG – widespread ST elevation or PR depression
• Echocardiography – pericardial effusion and thickened pericardium
• Inflammatory markers may be elevated
• Inflammation of the pericardium can be visualised on CT or MRI

Treatment

First-line treatment are NSAIDs + colchicine + exercise reduction. Second line are glucocorticoids and other immunosuppressants. In case of chronic pericarditis, pericardiectomy is an option.

Complications

• Constrictive pericarditis
• Cardiac tamponade