Pericarditis
- usually viral (esp Coxsackie) but may be other infections
- idiopathic
- uraemia
- neoplastic, paraneoplastic and post Rx eg. radiotherapy
- post MI (Dressler's syndrome)
Pain
- typically retrosternal but may radiate to trapezius M area
- typically pleurtic
- typically worse supine, better upright and leaning forward
Typical ECG changes - widespread concave upwards ST elevation & PR elevation with reciprocal ST depression and PR elevation in aVR which usually normalises from around 3/52
Management
- analgesia - NSAIDs, aspirin is especially good
- colchicine - some evidence to suggest it reduces recurrence
- steroids if contra-indications to NSAIDs
- reduce physical exertion
- admission if T>38 0C or other risk factors
- immunosuppressed
- anticoag's
- effusion
- trauma related
- rise in Trop
- worsening symptoms including failure of pain management after 1/52 (with NSAIDs, colchicine)
Exercise caution adding NSAIDs to patients already on anti-platelet or anti-coag agents. Not contraindicated, depending on cause, but all risk factors must be taken into account
References include:
NEJM review of non-MI ST elevation 2003
https://litfl.com/pericarditis-ecg-library/
https://www.uptodate.com/contents/acute-pericarditis-treatment-and-prognosis
https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up