Pericarditis is inflammation of the pericardium that commonly results in a pericardial effusion. It can be acute or chronic and has many potential causes including viral, bacterial, fungal infections, autoimmune diseases, uremia, drugs, malignancy, and idiopathic. Symptoms include chest pain and dyspnea while signs include a pericardial friction rub, irregular pulse, and diminished heart sounds. Diagnosis involves history, exam, labs, ECG, echo, and pericardiocentesis. Treatment is aimed at the underlying cause along with medications, while recurrent cases may require procedures like pericardiectomy. Complications can include cardiac tamponade, a

1. Ilkin Bakirli

2. Definition
• Inflammation of pericardium with abnormal amounts of pericardial fluid between
the visceral and parietal pericardium (pericardial effusion)
• Acute pericarditis is more common than chronic pericarditis
• Classified according to the composition of inflammatory exudate and the duration
of inflammation
• Types of exudates include serous, purulent, fibrinous, caseous, haemorrhagic, post
infarction

3. Clinical classification

4. Etiology
Infective Viral: Coxsackie, Adeno, Echo, HSV, mumps
Bacterial: Staphylococcal, Streptococcal, Mycobacterial
Fungal: Histoplasmosis,Coccidiosis,Candidiasis
Post-MI Early onset (in a few days) or late onset (2-10 weeks later)
Malignancy Mesothelioma of the heart, carcinoma of the lungs or breasts
Autoimmune SLE, RA,
Drug induced Isoniazid, cyclophosphamide
Chronic renal failure
Hypothyroidism
Iatrogenic Post-radiation, post-surgical
Idiopathic

5. Pathophysiology

6. Clinical manifestations
Symptoms Signs
Sharp, retrosternal stabbing pain, worse with
inspiration, improves while sitting, may radiate to
the shoulder
Pericardial frictional rub, best heard at the left
lower sternal border while the patient is leaning
forward
Fever Irregular pulse
Malaise Diminished heart sounds
Palpitations
Dyspnoea

7. Diagnosis
• History
• General exam: audible pericardial rub (high pitched squeaky sound)
• Laboratory tests: CBC: ↑CRP, ↑ESR, ↑WBC
Cardiac markers: ↑CK-MB, ↑Troponins
Renal function tests (BUN, creatinine)
Autoimmune antibodies
• CXR possible cardiomegaly
• ECG concave ST-elevation, PR segment depression, small QRS peak
• Pericardiocentesis: CBC, cytology, culture
• Echo, CT, MRI

8. ST-elevation

9. Treatment
• Treat the cause
• Bed rest
• Oral NSAIDs
• Glucocorticoids
• Antiobiotics
• Recurrent or relapsing disease colchicine, pericardiectomy

10. Chronic Pericarditis
• Idiopathic pericarditis may become chronic in 10-30% of cases
• The pericardium is chronically thickened or calcified resulting in constrictive
pericarditis, leading to impaired ventricular filling and subsequent decrease in
cardiac output
• Symptoms: dyspnoea, cough, peripheral edema, ascites, fatigue,
lightheadedness
• Signs: Kausmal’s sign (↑JVP), hepatosplenomegaly, hypotension,
tachycardia,
• Diagnosis: CXR: pericardial calcification. ECG:T wave flattening, AF is
common
Echo: thickened pericardium
• Treatment: pericardiectomy

11. Complication; CardiacTamponade
• Life-threatening condition resulting from an accumulation of excessive
fluid in the pericardial space (more than 50mL), leading to impaired
ventricular filling and decreased cardiac output
• Acute accumulation of upto 250ml or chronic accumulation upto 1L
• Symptoms:
Acute- Beck’s triad: Low BP + Distended neck veins + muffled heart
sounds
Subacute/Chronic- symptoms of RHF and LHF
• Signs: sinus tachycardia, ↑JVP, pulsus parodoxsus (>10mmHg fall in BP
on inspiration), frictional rub
• Diagnosis: CXR: enlarged cardiac silhouette. ECG: low voltage QRS
Echo, MRI, CT
• Treatment: pericardiocentesis, pericardial fenestration

12. Tamponade Constriction
↓CO ↓CO
JVD JVD
- Kausmal sign
Decreased heart sounds Pericardial knock
Pulsus parodoxus -
Large effusion -
RA and RV compression Pericardial thickening
Treatment: pericardiocentesis Treatment: pericardial stripping