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INTRODUCTION

ACUTE PERICARDITIS

Etiologies

TABLE 125-1MOST COMMON CAUSES OF PERICARDITIS

History

Chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic, and positional (relieved by leaning forward); fever and palpitations are common. Typical pain may not be present in slowly developing pericarditis (e.g., tuberculous, post-irradiation, neoplastic, uremic).

Physical Examination

Rapid or irregular pulse, coarse pericardial friction rub, which may vary in intensity and is loudest with pt sitting forward.

Laboratory ECG

Diffuse ST elevation (concave upward) usually present in all leads except aVR and V1; PR-segment depression (and/or PR elevation in lead aVR) may be present; days later (unlike acute MI), ST returns to baseline and T-wave inversion develops (See Table 125-2 and Fig. 125-1). Atrial premature beats and atrial fibrillation may appear. Differentiate from ECG of early repolarization (ER) (ratio of ST elevation/T wave height <0.25 in ER, but >0.25 in pericarditis).

TABLE 125-2ECG IN ACUTE PERICARDITIS VS ACUTE ST-ELEVATION MI
FIGURE 125-1

Electrocardiogram in acute pericarditis. Note diffuse ST-segment elevation and PR-segment depression.

CXR

Symmetrically increased size of cardiac silhouette if large (>250 mL) pericardial effusion is present.

Echocardiogram

Most readily available test for detection of pericardial effusion, which commonly accompanies acute pericarditis.

TREATMENT Acute Pericarditis

Aspirin 650–975 mg qid or other NSAIDs (e.g., ibuprofen 400–600 mg tid or indomethacin 25–50 mg tid); addition of colchicine 0.6 mg bid may be beneficial and reduces frequency of recurrences. For severe, refractory pain, prednisone 40–80 mg/d can be used as last resort. Intractable, prolonged pain or frequently recurrent episodes may require pericardiectomy. Anticoagulants are relatively contraindicated in acute pericarditis because of risk of ...

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