Pericarditis

Summary

Acute pericarditis is an inflammation of the pericardium that often presents with acute, sharp chest pain. It's found in approximately 5% of patients admitted to the emergency department for chest pain unrelated to acute myocardial infarction and affects men aged 20-50 more frequently. Management typically involves NSAIDs and colchicine, with glucocorticoids reserved for refractory cases or specific etiologies.

Key Terms

Pericardium

The membrane sac filled with serous fluid surrounding the heart.

Pleuritic Chest Pain

Sharp chest pain that worsens with breathing or coughing.

Epidemiology

• Found in approximately 5% of patients admitted to the ED for chest pain unrelated to AMI.
• Occurs most often in men 20 to 50 years of age.

Etiology

• Most attempts at determining etiology are inconclusive ¹
• Infection (viral, bacterial, fungal)
• Acute Myocardial Infarction
• Medication Use
• Trauma to the Thoracic Cavity
• Systemic Diseases (Rheumatoid Arthritis)
• Most cases are idiopathic/inconclusive.

Pathophysiology

• Inflammation of the pericardium can lead to chest pain, pericardial effusion, and potential complications like cardiac tamponade.

HPI

• Pain
  • Located usually retrosternal
  • Feels sharp
  • Can radiate to jaw, neck, arms, trapezius ridges, or shoulders
  • Varies in severity
  • Better with sitting or leaning forward because this reduces pressure on the parietal pericardium
  • Not better with nitrates
• Acute, sharp, retrosternal chest pain.
• Pain can radiate to jaw, neck, or arms.
• Pain varies in severity
• Pain is better with sitting or leaning forward because this reduces pressure on the parietal pericardium.

Physical Exam

• Pericardial friction rub (found in up to 85% of patients).

Diagnostics

• ECG: Widespread concave upward ST-segment elevation without reciprocal T-wave inversions or Q waves.

Treatment

• DONT
  • Glucocorticoids (reserved for severe/refractory cases or specific etiologies)
• NSAIDS
• Colchicine

Referrals

• Cardiology consultation is recommended for patients with severe disease, those with pericarditis refractory to empiric treatment, and those with unclear etiologies.

Case Study

Example: A 40-year-old male presents with sharp chest pain that worsens with inspiration and is relieved by sitting forward. He denies any recent trauma or illness. On examination, a pericardial friction rub is auscultated. What is the most likely diagnosis and initial treatment?

References

1. Snyder MJ, Bepko J, White M. Acute pericarditis: diagnosis and management. Am Fam Physician. 2014;89(7):553-560.
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