Chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic, and positional (relieved by leaning forward); fever and palpitations are common (See Table 116-1). Typical pain may not be present in slowly developing pericarditis (e.g., tuberculous, post-irradiation, neoplastic, uremic).
TABLE 116-1ETIOLOGIES OF PERICARDITIS ||Download (.pdf) TABLE 116-1ETIOLOGIES OF PERICARDITIS
|Infections (particularly viral) |
|Connective tissue disease (e.g., rheumatoid arthritis, SLE) |
|Post-cardiac injury (i.e., following heart surgery or myocardial infarction) |
|Mediastinal radiation therapy |
|Drug reaction (e.g., procainamide, hydralazine) |
Rapid or irregular pulse, coarse pericardial friction rub, which may vary in intensity and is loudest with pt sitting forward.
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 116-2 and Fig. 116-1). 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 116-2ECG IN ACUTE PERICARDITIS VS ACUTE ST-ELEVATION MI ||Download (.pdf) TABLE 116-2ECG IN ACUTE PERICARDITIS VS ACUTE ST-ELEVATION MI
|ST-Segment Elevation ||ECG Lead Involvement ||Evolution of ST and T Waves ||PR-Segment Deviation |
|Concave upward ||All leads involved except aVR and V1 ||ST remains elevated for several days; after ST returns to baseline, T waves invert ||Yes, in majority |
|Acute ST elevation MI |
|Convex upward ||ST elevation over infarcted region only; reciprocal ST depression in opposite leads ||In absence of successful reperfusion therapies: T waves invert within hours, while ST still elevated; followed by Q-wave development ||No |
Electrocardiogram in acute pericarditis. Note diffuse ST-segment elevation and PR-segment depression.
Symmetrically increased size of cardiac silhouette if large (>250 mL) pericardial effusion is present.
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, glucocorticoids (e.g., prednisone) can be prescribed. Intractable, prolonged pain or frequently recurrent episodes may require pericardiectomy. Anticoagulants are relatively contraindicated in acute pericarditis because of risk of pericardial hemorrhage.
Life-threatening condition resulting from ...