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
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.