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Pericarditis

John Mitchell

Background

  • Inflammation of the pericardial sac
  • Etiologies:
  • Infectious: Viral (Coxsackievirus, adenovirus, COVID-19), bacterial (TB, staph, strep), fungal
  • Inflammatory: Rheumatologic (most commonly SLE and RA), post-radiation, vaccine reaction, post pericardiotomy syndrome
  • Cardiac: Infarction (Dressler syndrome) and myocarditis
  • Miscellaneous: Trauma (including procedures e.g. cath, cardiac surgery), metabolic (uremia, hypothyroid), drug-induced, malignancy
  • Idiopathic (most common cause, assumed to be viral/post-viral)

Presentation

  • At least two criteria of four should be present:
  • Sharp substernal pleuritic chest pain that is better with leaning forward
  • Pericardial friction rub
  • New widespread ST elevation and PR depression
  • New or worsening pericardial effusion
  • Chest pain almost always present. Pericardial rub highly specific
  • Even small effusion can help confirm diagnosis, but lack thereof does not rule it out

Evaluation and Management

  • Always: EKG, chest x-ray, BMP, CBC, troponin, ESR, CRP and TTE
  • TTE should be performed ASAP if tamponade suspected
  • In select populations if warranted: Blood cultures, ANA, RF, anti-CCP, PPD, chest CT
  • Treatment:
  • NSAIDs (or glucocorticoids if contraindications to NSAIDs) AND colchicine
    • Ibuprofen 600-800mg TID (duration based on symptom resolution and normalization of CRP)
    • Prednisone 0.2-0.5mg/kg daily for 2 weeks followed by tape
    • Colchicine 0.6mg orally BID for 3 months