Pericarditis

Acute pericarditis is a clinical diagnosis.

Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position.

The classic physical finding is a pericardial friction rub. A low-grade fever is often present.

Diagnostic signs include new widespread diffuse concave upwards ST elevation and/or PR depression on ECG and new or worsening pericardial effusion on echocardiography; blood tests generally suggest systemic inflammation.

Cardiac tamponade is a life-threatening complication of acute pericarditis. These patients require urgent pericardiocentesis.

All patients should be given a non-steroidal anti-inflammatory drug as first-line treatment. Colchicine should also be given, unless the patient has tuberculous pericarditis.

Further treatment is directed at any underlying systemic disorder.

Complications include chronic recurrent pericarditis, cardiac tamponade, and constrictive pericarditis.

Pericarditis is an inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4 to 6 weeks. It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice.

This topic covers both acute and recurrent pericarditis in adults. Children are not covered in this topic.