• Clinical science

Pericarditis

Abstract

Acute pericarditis is an inflammation of the pericardium that is most commonly caused by infection or myocardial infarction, or occurs following cardiac surgery. The condition typically presents with fever, pleuritic chest pain, and a pericardial friction rub heard on auscultation. The diagnosis is established based on clinical findings, although diffuse ST segment elevations on ECG and imaging may support the diagnosis. Acute pericarditis is usually self-limiting within 2–6 weeks and is therefore managed symptomatically. Constrictive pericarditis occurs as a complication of acute pericarditis and is characterized by thickening and rigidity of the pericardium, resulting in both backward and forward failure. Accordingly, patients present with fatigue, jugular vein distention, peripheral edema, and a characteristic pericardial knock on auscultation, caused by a sudden stop in ventricular diastolic filling. Diagnostic imaging shows typical pericardial thickening on chest x-ray and reduced blood flow on echocardiography. Management consists of treatment of heart failure (e.g., diuretics) and pericardiectomy.

Definition

References:[1][2]

Etiology

Tuberculosis is the most common cause of constrictive pericarditis in developing countries.

References:[3][4][2]

Clinical features

Acute pericarditis

Constrictive pericarditis

References:[5][6][7][8][9][2]

Diagnostics

Acute pericarditis

The diagnosis is based primarily on a history of pleuritic chest pain and a friction rub heard on auscultation. It is supported by the following findings:

Constrictive pericarditis

  • Chest x-ray (best initial test); , CT, and MRI: pericardial thickening and calcifications, normal cardiac silhouette
  • Echocardiography
  • ECG shows no conclusive findings.
  • Cardiac catheterization
    • Elevated diastolic pressures in the left and right ventricles with diastolic equalization
    • Mean right arterial pressure > 15 mm Hg
    • Right ventricular end-diastolic pressure > ⅓ of the systolic pressure
    • Square root sign
      • Also known as dip-and-plateau waveform
      • Sudden dip of the right and left ventricular pressure in early diastole followed by a plateau during the last stage of diastole

References:[8][5][6][7][10][11][12][13][2]

Treatment

Acute pericarditis

Acute pericarditis is often self-limiting and resolves within approx. 2–6 weeks.

Constrictive pericarditis

  • Treat underlying condition
  • Symptomatic therapy; (manage fluid overload with diuretic therapy)
  • Pericardiectomy (complete removal of the pericardium)

References:[14][6][2]

Complications

References:[5]

We list the most important complications. The selection is not exhaustive.