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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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