Introduction
Pericarditis is an inflammation of the pericardium, which may arise from viral, bacterial, fungal or protozoal infections.
Other causes of pericarditis include: metabolic, malignancy, connective tissue disease, radiation, trauma etc.
Pericarditis may be acute or chronic
Clinical features
Acute pericarditis:
- Chest pain
- Retrosternal
- Sharp
- Radiating to the left shoulder
- Made worse by breathing or coughing
- Relieved by the upright position
- Low-grade fever
- Pericardial friction rub
Chronic pericarditis:
Insidious onset
There may be:
- Dyspnoea on exertion
- Leg and abdominal swelling
Differential diagnoses
- Endomyocardial fibrosis
- Sarcodosis
- Amyloidosis
Complications
- Pericardial tamponade
- Constrictive pericarditis
Investigations
- Electrocardiography
- Full Blood Count and differentials
- Chest radiograph
- Echocardiography
Treatment objectives
- Relieve distress from pain and tamponade
- Relieve constriction
- Treat the effect on the heart
- Treat complications
- Eradicate the organism (if cause is infection)
Non-drug treatment
- Bed rest
Drug treatment
NSAIDs
- Indomthaem 50 mg orally every 8 hours
Or:
- Ibuprofen 400-800 mg orally every 12 hours
Steroids
- Prednisolone 30 mg orally every 8 hours and tapered
Anti-tuberculous drugs or other
antimicrobial agents (if mycobacterium
or other microbes are causative)
Supportive measures
- Pericardiocentesis.
- Pericardiectomy
Notable adverse drug reactions
- NSAIDs/steroids: dyspepsia and upper GI bleeding
Prevention
- Avoid radiation
- Prevent infection.