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ACUTE PERICARDITIS

ETIOLOGIES

TABLE 118-1Etiologies of Pericarditis

HISTORY

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).

PHYSICAL EXAMINATION

Rapid or irregular pulse, coarse pericardial friction rub (may come and go); 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 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
FIGURE 118-1

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

CXR

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

ECHOCARDIOGRAM

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

TREATMENT

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., ...

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