TABLE 118-1Etiologies of Pericarditis |Favorite Table|Download (.pdf) TABLE 118-1 Etiologies of Pericarditis
Infections (particularly viral)
Collagen vascular 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)
Chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic, positional (relieved by leaning forward). Pain is usually retrosternal or left precordial, radiating to neck, left shoulder, trapezius ridge, and/or arms; fever and palpitations are common. Typical pain may not be present in slowly developing pericarditis (e.g., tuberculous, post-irradiation, neoplastic, uremic).
Rapid or irregular pulse, coarse pericardial friction rub (may come and go); 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 ST returns to baseline and T-wave inversion then develops (see Table 118-2 and Fig. 118-1). Distinguish from acute ST elevation MI (in which ST elevations are upwardly convex with reciprocal ST depression in opposite leads, PR depression does not occur, and T wave inversions appear while ST segments are still elevated). Differentiate from ECG of early repolarization (ER) (ratio of ST elevation/T wave height <0.25 in ER, but >0.25 in pericarditis). Atrial premature beats and atrial fibrillation are common.
TABLE 118-2ECG in Acute Pericarditis vs Acute ST-Elevation MI |Favorite Table|Download (.pdf) TABLE 118-2 ECG in Acute Pericarditis vs Acute ST-Elevation MI
|ST-SEGMENT POSITION ||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 only 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 600−800 mg tid or indomethacin 25–50 mg tid; at higher doses, consider gastric protection, e.g., ...