Pericarditis🫀

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Pericarditis🫀 

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🔹 Definitions & Variants

  • Acute pericarditis – inflammation of pericardium, often viral/idiopathic

  • Perimyocarditis – myocardium primarily affected, with pericardial involvement

  • Recurrent pericarditis – symptoms recur after ≥4–6 weeks symptom-free

  • Transient constrictive pericarditis – constrictive physiology < 3 months

  • Chronic pericarditis – inflammation > 3 months

  • Constrictive pericarditis – thickened, fibrotic pericardium → impaired filling

  • Effusive-constrictive pericarditis – effusion + rigid pericardium

🔹 Etiology

  • Idiopathic / Viral – most common (e.g., Coxsackievirus B)

  • Bacterial – Strep, Staph, TB

  • Post-MI

    • Early fibrinous (1–3 days)

    • Dressler syndrome (weeks later, autoimmune)

  • Uremia – acute or chronic renal failure

  • Neoplasms – e.g., lymphoma

  • Autoimmune – SLE, RA, scleroderma

  • Radiation (acute vs late constrictive)

  • Trauma / Post-surgery (postpericardiotomy)

  • Others – fungal, toxoplasmosis, vaccines (rare, e.g., mRNA COVID-19)

  • Fibrinous pericarditis
    with uremia 

🔹 Clinical Features

Acute Pericarditis

  • Chest pain: sharp, pleuritic, worse lying flat / deep breathing, relieved by sitting forward

  • Pericardial friction rub: high-pitched, “scratchy” – best at LSB leaning forward

  • Low-grade fever, tachypnea, dyspnea, cough

  • May progress to effusion or tamponade

Constrictive Pericarditis

  • Right-sided failure signs: JVD, hepatomegaly, ascites, edema

  • Kussmaul sign: ↑ JVP with inspiration

  • Pericardial knock: early diastolic sound

  • Pulsus paradoxus (sometimes)

  • Symptoms of low CO: fatigue, dyspnea

Effusive-Constrictive

  • Mixed features of effusion + constriction

  • Persistent ↑ RA pressure after pericardiocentesis is typical

 Diagnosis

Clinical Criteria (≥2 of 4 for acute pericarditis):

  1. Typical chest pain

  2. Pericardial friction rub

  3. Typical ECG changes

  4. New/worsening effusion

ECG Stages

  • Stage 1: Diffuse ST ↑, PR ↓

  • Stage 2: ST normalization

  • Stage 3: T inversion

  • Stage 4: Recovery


Imaging

  • Echo: effusion, tamponade, ventricular interdependence


  • MRI/CT: thickened, enhanced pericardium (better for chronic/constrictive)


  • CXR: usually normal; may show large silhouette (effusion) or calcifications (chronic)


Cath findings (constrictive)

  • Equalization of diastolic pressures

  • Square root sign (dip & plateau)

🔹 Treatment

Medical

  • NSAIDs (ibuprofen, aspirin, indomethacin)

  • Colchicine – reduces recurrence

  • Steroids – reserved for autoimmune/uremia/refractory cases

  • Antibiotics / TB therapy – if infectious cause

  • Dialysis – for uremic pericarditis

Surgical

  • Pericardiocentesis – tamponade, large effusion, purulent pericarditis

  • Pericardiectomy – definitive for constrictive pericarditis

🔹 Complications

  • Cardiac tamponade

  • Constrictive pericarditis

  • Recurrent pericarditis

  • Heart failure symptoms

✅ Key Exam Pearls

  • Chest pain better sitting forward, worse lying down → pericarditis

  • Diffuse ST elevation + PR depression → pericarditis (not MI)

  • Dressler syndrome = autoimmune, weeks post-MI

  • Kussmaul sign + pericardial knock → constrictive pericarditis

  • Square root sign on cath → constriction


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