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What is the primary therapy to initiate if the diagnosis of acute pericarditis is likely or certain?
Which of the following laboratory tests is most likely to be elevated in acute pericarditis?
Which symptom is NOT commonly associated with acute pericarditis?
In most cases of acute idiopathic pericarditis, what diagnostic imaging is typically expected to be normal?
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In treating acute pericarditis, how long is colchicine given for prevention of recurrence if unresponsive to NSAIDs?
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What is the duration for which NSAIDs are prescribed for acute pericarditis treatment?
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Which of the following conditions is part of the differential diagnosis for acute pericarditis?
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What might an elevated hsCRP indicate in a patient suspected of having acute pericarditis?
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What is the primary composition of the visceral pericardium?
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Which of the following best describes the parietal layer of the pericardium?
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What can be found in the pericardial space?
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Which symptom is typically associated with pericardial pain?
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In which scenario might serum ANA testing be considered?
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What is the most common cause of constrictive pericarditis according to the information provided?
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Which of the following laboratory results indicates an inflammatory process?
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What is the prognosis for uncomplicated constrictive pericarditis?
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What percentage of patients with nonischemic chest pain at the emergency department may have pericarditis?
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What is a common characteristic of complicated pericarditis?
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Which of the following is a reason why specific viral testing for pericarditis is not routine?
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What is typically the duration of symptoms resulting from pericardial inflammation?
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Which type of pericarditis may present with chronic symptoms?
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Study Notes
Acute Pericarditis
- Inflamed pericardium, usually lasting 1-2 weeks
- Most cases are idiopathic (no specific cause)
- Viral etiology is suspected but rarely tested for due to cost, low yield, and negligible impact on management
Anatomy and Physiology of the Pericardium
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Two layers:
- Visceral pericardium: adheres to the epicardial surface of the heart. Contains collagen and elastin fibers.
- Parietal layer: fibrous layer that surrounds most of the heart. Composed of collagen and elastin fibers.
- Pericardial space: located between the visceral and parietal layers
Symptoms
- Chest pain: Severe, pleuritic, rapid onset, substernal/left anterior aspect of chest/epigastrium, radiates to left arm/trapezius ridge. Relieved by sitting forward and worsened when lying down.
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Other symptoms:
- Uncomfortable
- Anxious
- Low-grade fever
- Sinus tachycardia
- Friction rub (pathognomonic and sounds like "walking on crunchy snow")
Differential Diagnosis
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Possible conditions to differentiate:
- Pneumonia
- Pulmonary embolism/infarction
- Costochondritis
- Gastroesophageal reflux disease
- Aortic dissection
- Intra-abdominal processes
- Pneumothorax
- Herpes zoster pain
- Precede silent MI
Initial Approach to Patients with Suspected Acute Pericarditis
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Initial tests:
- Chest radiograph
- Hemogram
- hsCRP
- Echocardiogram
- Troponin I
- Consider serum ANA for young females
- Initial therapy: NSAID + colchicine if diagnosis is confirmed
Laboratory Testing
- Hemogram: Modestly elevated WBC count with mild lymphocytosis
- Troponin I: Elevated in 15% of cases. No left ventricular dysfunction in most cases
- hsCRP: Elevated in ~3/4 of patients
Chest X-Ray
- Usually normal
- Small infiltrates
- Pleural effusion
Echocardiography
- Normal in most cases of acute idiopathic pericarditis
- Detects pericardial effusion
MRI/CT
- Pericardial thickening
- Increased gadolinium uptake (active inflammation)
Natural History and Management
-
NSAIDS: 10-14 days
- Ibuprofen (600-800mg TID)
- Acetylsalicylic acid (2-4gm daily in divided doses)
-
Colchicine: Prevention of recurrence and unresponsive to NSAIDS, given for 3 months.
- Dose: 0.5mg BID for those >70kg
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Description
Explore the key aspects of Acute Pericarditis, including its causes, symptoms, and the anatomy of the pericardium. Understand the typical duration and characteristics of this condition, as well as the clinical implications of its symptoms. This quiz is designed to enhance your understanding of pericardial diseases.
