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Pathology
Inflammation of the pericardium, usually lasting less than six weeks duration.
It is the commonest pathology of the pericardium
Aetiology
Idiopathic
Infection: Viral (Coxsackievirus), bacteria (Staphylococcus or Streptococcus),
mycoplasma, fungal, parasitic, Infective endocarditis
Radiation
Neoplasm: Primary (rhabdomyosarcoma), metastatic (lung or breast cancer)
Cardiac: Myocarditis, dissecting aortic aneurysm, Dressler’s syndrome
Trauma: Blunt, penetrating, iatrogenic
Autoimmune: Lupus, rheumatoid arthritis, scleroderma, vasculitis
Drugs: Procainamide, isoniazid, Hydralazine
Metabolic: Hypothyroidism, uraemia, ovarian hyperstimulation syndrome
Signs
Pericardial rub (scratching sound best heard over the left sternal edge), signs of cardiac tamponade
Symptoms
Pleuritic central chest pain (improved on leaning forward or sitting up), fever
Investigations
Blood: FBC, CRP, ESR
Viral Titres: Acute and convalescent titres
ECG: Diffuse concave ST elevation with PR depression
Echo: Assessing structure and function and evidence of pericardial effusion
Treatment
NSAIDs are first line
Corticosteroids can be used if NSAID’s contraindicated
Colchicine is used for refractory cases
Prognosis
Usually good for viral pericarditis.
15-40% relapse and have a poorer prognosis than the first episode.
Cardiac tamponade or constrictive pericarditis may occur in those with malignancy or tuberculosis
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