Acute Pericarditis – What is it, its features, diagnosis, and treatment

(Acute Pericarditis video – Click to skip to video)

Acute Pericarditis is the acute inflammation of the Pericardium.

 Causes

1. Viral (common cause) – Coxsackie B, Echovirus
2. Uremia
3. Tuberculous pericarditis
4. Connective tissue diseases – SLE, Scleroderma
5. Post-Myocardial Infarction – on 2nd or 3rd day or in Dressler’s syndrome
6. Bacterial infections – Staph aureus, H. influenzae
7. Acute Rheumatic Fever
8. Malignancy – From carcinoma of bronchus, breast; lymphoma, leukaemia
9. Drugs – Doxorubicin, Cyclophosphamide
10. Radiation
11. Fungal – Histoplasmosis, Coccidioidomycosis

 Symptoms

1. The main symptom is chest pain which is retrosternal, sharp or stabbing in nature, may radiate to the shoulder and neck.
2. Aggravated by movement, lying down, deep breathing, exercise & swallowing.
3. Pain is relieved by sitting or bending forward.
4. Symptoms related to the diseases causing pericarditis (e.g. low-grade evening rise of temperature, night sweat weight loss in TB).

 Signs

The prominent sign of Pericarditis is pericardial friction rub which is produced due to rubbing of inflamed & roughened visceral & parietal pericardial surfaces against each other. Its characteristics are as follows:

• It is a high-pitched, harsh, scratching, grating, leathery sound, to and fro in quality.
• Better heard over the left lower parasternal region with the patient leaning forward.
• Augmented by pressing the stethoscope.
• Usually heard in systole, but maybe in diastole.
• Present even after holding the breath (to differentiate from pleural rub).

 Investigations

ECG – ST-elevated with an upward concavity in most of the leads (Saddle-shaped) 

Chest X-ray – usually normal but may show effusion and other features of associated diseases in chest.

Echocardiography – A valuable tool to exclude pericardial effusion and to see cardiac structure & function.

Other tests—To look for causative disease

 Treatment

1. Symptomatic Treatment
   • Analgesia – NSAIDs (Indomethacin or Ibuprofen)
   • In severe or recurrent pain—Corticosteroids may be tried but they do not accelerate the cure
   • If no response to steroid—Azathioprine or Colchicine may be added
   • If recurrence with no response to medical treatment—Pericardiotomy may be done
2. Treatment of Primary cause. e.g., antibiotic for a bacterial infection or Anti-TB treatment, if tuberculosis is diagnosed.