Pericarditis Board and Resident Review Points

Pericarditis

Acute pericarditis usually presents with sharp retrosternal pain that worsens by lying down/inspirations and improves with sitting/leaning forward. Friction rub audible mainly at the left sternal border while the patient is leaning forward especially during expiration. There is a long list of etiologies, however, in the exam look for a hint for the cause in the question. The most common cause is viral illness and hence look for recent history of fever/cough. Other common scenarios include postcommissurotomy (postpericardiotomy) syndrome which happens few weeks after cardiac surgery and Dressler syndrome which happens after myocardial infarction. Pericarditis can be complicated with pericardial effusion and temponade.

EKG will typically show diffuse ST-elevation and PR depression in all the leads. If there is also diffuse T-wave inversion then think about associated Myocarditis. Although both can cause elevated cardiac enzymes, however, it is more pronounced with myocarditis. Inflammatory markers like WBCs, ESR and CRP can be elevated.

Treatment of pericarditis is usually by a combination of Colchicine and a NSAIDs (like Ibuprofen, Indomethacin or Aspirin).

While preparing this post, I came through some articles on some medical and non-medical websites advocating for following an anti-inflammatory diet for treating various inflammatory issues in the body, though no strong scientific evidence yet.

         This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your doctor or local emergency services.