PERICARDITIS

Inflammation of the heart membrane (pericardium), which may be:

  • Acute and self-limiting, sub-acute or chronic
  • Fibrinous, serous, haemorrhagic or purulent

Causes

  • Idiopathic or viral (most common causes) e.g. Coxsackie A and B, influenza A & B, varicella
  • Bacterial e.g. mycobacterium, staphylococcus, meningococcus, streptococcus, pneumococcus, gonococcus, mycoplasma
  • Fungal: Histoplasmosis
  • Severe kidney failure (less common)
  • Hypersensitivity such as acute rheumatic fever
  • Myocardial infarction
  • Radiation, trauma, neoplasms

Clinical features

  • Pericarditis without effusion: retrosternal pain radiating to shoulder, which worsens on deep breathing, movement, change of position or exercise; pericardial rub is a diagnostic sign
  • Pericardial effusion: reduced cardiac impulses, muffled heart sounds, cardiomegaly
  • Cardiac tamponade (compression) in case of massive effusion or constrictive pericarditis: dyspnoea, restlessness, rising pulmonary and systemic venous pressure, rapid heart rate, pulsus paradoxus, low BP, and
    low output cardiac failure

Differential diagnosis

  • Other causes of chest pain
  • Other cause of heart failure

Investigations

  • ECG, chest X-ray
  • Echo-cardiography

Management

If viral or idiopathic

  • Rest
  • Ibuprofen 600 mg every 8 hours
  • If there is fluid, perform tapping

If other causes, treat accordingly

Prevention

  • Early detection and treatment of potential (treatable) causes