View source for 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 virus|coxsackie]], others)
** Bacterial
* Non-infectious
** Autoimmune (<abbr>[[Systemic lupus erythematosus|SLE]]</abbr>, [[Sjögren syndrome|Sjögren]], [[Rheumatoid arthritis|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.

* [[Chest X-ray|X-ray]] – enlarged cardiac silhouette due to [[pericardial effusion]]
* [[Electrocardiogram|ECG]] – widespread ST elevation or PR depression
* [[Echocardiography]] – pericardial effusion and thickened pericardium
* [[Inflammatory marker|Inflammatory markers]] may be elevated
* Inflammation of the pericardium can be visualised on [[Computer tomography (CT)|CT]] or [[Magnetic resonance imaging (MRI)|MRI]]

== Treatment ==
First-line treatment are [[Non-steroidal anti-inflammatory drug|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]]

[[Category:Cardiology]]