Pericardial Disease Overview

Watch ▶Pericardial disease: Pathology review

Acute Pericarditis

Watch ▶Pericarditis: Clinical sciences

Definition

• Inflammation of the pericardial sac.

Etiology

• Viral (e.g., Coxsackie, echovirus, adenovirus)
• Bacterial (e.g., tuberculosis)
• Fungal infections
• Uremia
• Post-acute myocardial infarction
  • Fibrinous ⇒ Early
  • Dressler syndrome ⇒ Late

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1️⃣ 72M + had STEMI two days ago + now has central friction rub → post-MI fibrinous pericarditis.

2️⃣ 72M + had STEMI 2-6 weeks ago + now has central friction rub → Dressler syndrome

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• Autoimmune conditions (e.g., collagen vascular diseases)
• Surgery, trauma, or radiation

Clinical Features

• Severe pleuritic chest pain
  • Typically relieved by sitting up or leaning forward
• Pericardial friction rub
  • Specific finding
  • Described as triphasic scratchy or squeaky ⇒ heard in atrial systole, ventricular systole, and early ventricular diastole

Diagnosis

• Clinical criteria (≥ 2 of the following)
  1. Classic positional chest pain
  2. Pericardial friction rub
  3. Typical ECG changes
  4. Pericardial effusion on imaging
• ECG changes
  • Diffuse PR depressions & diffuse ST elevations
• Transthoracic echocardiogram (TTE)
  • Initial Imaging test
  • Indicated in all cases to exclude concurrent effusion
  • Often shows pericardial effusion in about 50% of cases