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Essentials of Diagnosis
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General Considerations
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Often associated with pleuritic chest pain, relieved by sitting, that radiates to the neck, shoulders, back, or epigastrium
Dyspnea and fever
Pericardial friction rub with or without evidence of pericardial effusion or constriction
Tuberculous pericarditis
Rare in developed countries; results from direct lymphatic or hematogenous spread
Pericardial effusions are usually small or moderate but may be large when chronic
Clinical pulmonary involvement may be absent or minor, although associated pleural effusions are common
Nonspecific symptoms (fever, night sweats, fatigue) may be present for days to months
Pericardial involvement occurs in 1–8% of patients with pulmonary tuberculosis
Bacterial pericarditis: rare; patients appear toxic and are often critically ill
Uremic pericarditis: symptoms may or may not be present; fever is absent
Neoplastic pericarditis: often painless, there may be hemodynamic compromise
Post-MI or postcardiotomy pericarditis (Dressler syndrome)
Occurs days to weeks to several months after MI or open heart surgery
May be recurrent
Probably represents an autoimmune syndrome
Patients present with typical pain, fever, malaise, and leukocytosis
Joint pain and fever rarely occur
Tamponade is rare post-MI but not postoperatively
Radiation pericarditis