- Inflammation of the pericardium.
- 90% of cases are idiopathic or related to viral infections.
- Complications can include developing pericardial effusion, tamponade, and constriction.
- Treatment generally with ASA/NSAIDS and Colchicine.
- Idiopathic (most common as exact cause is usually not identified)
- Viral: Echovirus, Adenovirus, Coxsackievirus, CMV, EBV, Parvovirus, Influenza, HIV
- Bacterial: (similar to lung infections, can also be from extension of primary lung infection) Staph, Strep, Pneumococcus, Haemophilus, Mycoplasma, Legionella, Gonococcus
- Fungal: Coccidiodomycosis, Histoplasmosis
- Mycobacterium: Tuberculosis, Avium.
- Parasites: Toxoplasmosis, Echinococcosis
- Primary: Angiosarcoma, Mesothelioma, Paraganglioma, Lipoma
- Secondary: Lung, Breast, Lymphoma, GI, Melanoma, Kaposi Sarcoma,
- Collagen diseases: Lupus, Rheumatoid Arthritis, Scleroderma, Sjogren’s
- Vasculitis: Giant Cell Arteritis, Churg-Strauss, Polyarteritis Nodosa
- Rheumatic Fever
- Inflammatory Bowel Disease
- Medications: Hydralazine, Procainamide, Doxorubicin, Cyclosporine, Cyclophosphamide
- Post-Myocardial Infarction
- Congenital: absence of pericardium
- Renal failure (Uremia)
- Pleuritic retrosternal chest pain.
- Pain often radiates to back or trapezius.
- Pain is worse when lying flat and relieved by siting forward.
- Associated symptoms include, dyspnea, fever, tachycardia, and occasionally signs of tamponade.
- Pericardial friction rub “classic/pathognomonic” finding, best heard with the patient sitting forward on end expiration
Diagnosis confirmed if 2 out of 4 classic features
- 1) Classic pleuritic chest pain that is positional.
- 2) Typical ECG changes.
- 3) Pericardial friction rub.
- 4) Pericardial effusion.
- Standard bloodwork: CBC, lytes, urea, creatinine, liver enzymes.
- Troponin (If positive consider myopericarditis or prior myocardial infarction).
- CRP (Confirm inflammatory process, most patients with pericarditis will have an elevated CRP. Therefore, helpful test to rule out pericarditis if negative. Also useful for tracking response to treatment).
- Consider: Autoimmune work-up (ANA, ANCA, RF), HIV, HCV, TSH, malignancy work-up, if clinical suspicion.
ECG (4 Phases)
- Diffuse ST elevation (upsloping/concave), with PR depression, and reciprocal changes in aVR.
- Normalization of ST segments
- T-wave inversions
- T-wave normalization
- Looking for pericardial effusion as most patients will have this in pericarditis.
- Must rule out cardiac tamponade clinically (echocardiogram can be helpful)
- Pericardiocentesis is rarely required unless there is tamponade physiology, suspected bacterial or malignant cause.
- If any predictors of poor prognosis are present or if no response to NSAIDS, patient should be admitted and search for etiology
- Consider POCUS for patients to assess for large effusion before discharge
- High dose NSAID’s (ie. Ibuprofen 600-800mg QID) or ASA (650mg QID) for 1-2 weeks.
- Colchicine 0.5mg bid or if less than 70kg 0.5mg daily for 3 months (decreases recurrence).
- Low dose corticosteroids (ie. 0.2-0.5mg/kg/day) can be used with failure/contraindication to ASA/NSAIDS with colchicine or with autoimmune etiology.
- Proton Pump Inhibitor while on high dose NSAIDS/ASA.
- Primary Author: Dr. Daniel Durocher (MD, FRCPC, Cardiology Fellow)
- Author/Reviewer: Dr. Atul Jaidka (MD, FRCPC, Cardiology Fellow), Dr. Pavel Antiperovitch (MD, FRCPC)
- Staff Reviewer: Pending
- Last Updated: March 22, 2020