Pericarditis
OVERVIEW
- Pericarditis = inflammation in the pericardium
CAUSES
- uraemia
- viral infection (all causes of myocarditis)
- bacterial infection
- radioation
- malignancy (metastatic: lung>breast>leukaemia and lymphoma>melanoma)
- vasculitis
- autoimmune (SLE, RA, scleroderma, sarcoid…)
- Tb
- other
ASSESSMENT
HISTORY
- chest pain (sharp, dull, burning, pressing, radiation -> trapezius ridge, worse on inspiration, lying flat and movement)
- SOB
- fever
EXAMINATION
- pericardial rub (most are triphasic)
- tachypnoea
- tachycardia
- fever
INVESTIGATIONS
- ECG (4 stages):
- diffuse ST elevation with PR depression
- resolution of stage 1 with TW flattening
- deep symmetrical TW inversion
- resolution
- cardiac enzymes (30% elevated)
- CXR: if tamponade suspected
- ECHO: gold standard
MANAGEMENT
- O2
- telemetry
- R/O life threatening causes of chest pain
- NSAIDS
- tamponade -> pericardiocentesis
- if infectious: antibiotics
- many managed as an outpatient
- cardiology and cardiothoracic opinion if indicated
References and links
- LITFL ECG library – Pericarditis
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC