22  Pericarditis

Pericarditis
- EKG
- Labs
    - BMP
    - Trop - usually +, so not helpful from distinguishing other causes of CP
    - TB - Quantiferon
    - ANA
    - BC
- Imaging
    - Echo
    - CXR
- Treatment
    - NSAIDs
    - Colchicine - shown to improve Tx response and decrease disease recurrence
    - Predisone if refractory and other diseases are ruled out
- Pericardiocentesis if tamponade

• Typical illness script
  • Hx: young adults, with 1 week of viral symptoms and chest pain that improves with leaning forward
  • Physical exam: 3-part friction rub
  • ECG: ST elevations and PR depressions in all leads
  • EKG
    • most commonly widespread ST elevations and PR depressions
    • Differentiate from acute MI. Differentiating factors:
      • ST elevation
        • Pericarditis: usually diffuse
        • MI: usually localized to leads associated with the area of ischemia/infarction
      • PR depression is very uncommon in acute MI
      • Q waves are not present with pericarditis
  • DDx:
    • Viral pericarditis; primarily caused by coxsackievirus, echovirus, and adenovirus
    • Other infectious, e.g. TB, HIV
    • Post-MI and postcardiac surgery
    • Rheum: includes SLE and RA
    • Meds: includes procainamide and hydralazine
    • Malignancy that has metastasized to the pericardium
    • Chest irradiation
    • Uremia
  • Complications:
    • Pleural effusions
    • ⚠️ Cardiac tamponad

Warning

Pts w/ uremic pericarditis often do not present with ‘classic’ EKG features