It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. Pericarditis may occur in association with chronic or acute kidney injury.Metastatic lung and breast cancer are the commonest malignancies to cause acute pericarditis. A troponin rise is partially related to the extent of coexisting myocardial inflammation but, unlike in acute coronary syndromes, elevation in troponin is not associated with adverse outcome in pericarditis [13]. ).NSAIDS are the mainstay of treatment for pericarditis (e.g. Most cases are idiopathic (80-90%) [5]. Aspirin is used preferentially if pericarditis is a complication of acute myocardial infarction.Steroids are not indicated for acute pericarditis in the early phase as they are associated with an increased risk of relapsing pericarditis. However, if the troponin is raised the patient should be considered to have myopericarditis and as this is a feature of poor prognosis further inpatient workup should be considered.The use of Echocardiography is important to help aid diagnosis and to consider the presence of large pericardial effusion or cardiac tamponade which are poor prognostic factors potentially requiring further management. Well. The combined thickness of these 2 layers should measure less than 2mm [1].

Published waveforms (eg. As the disease progresses so may the ECG: there may be notched T waves, biphasic T waves or T wave inversion. Pericarditis is a complex condition which can be hard to diagnose. These patients should be admitted for inpatient management.Typical ECG changes however have been reported to occur in only 60% of cases. Acute Pericarditis is a well-recognised cause of chest pain. It can cause a direct infective pericarditis or pericarditis can be associated with other opportunistic infections such as CMV. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes.

These high risk features (see Table below) are associated with a poorer prognosis and may help guide the need for inpatient management [5].To help establish the diagnosis and look for high risk features a number of simple investigations should be performed within the ED.As well as looking for the characteristic features of pericarditis on the ECG it will also help to distinguish other potential causes of chest pain.There are a number of ECG features which are characteristic of acute pericarditis (Fig 1):Classically the evolution in pericarditis occurs in 4 stages:The above ECG changes are seen in the acute phase of pericarditis and are likely to be seen within the ED. Athletes should be advised not to compete in competitive sports for at least 3 months following resolution.Adding colchicine to NSAIDS should be strongly considered as it has been shown to reduce symptoms, decrease the rate of recurrent pericarditis, and the low dose regimen (0.5-1.2mg daily) is generally well tolerated.

Swami is an associate editor for REBEL EM and REBEL Cast. In a normal physiological state the pericardial sac between these 2 layers contains 15-50mls of fluid. A diagnosis of myopericarditis requires full clinical assessment including ECG, troponin and Echocardiography.Any obvious underlying cause for acute pericarditis should be treated (eg. How is pericarditis treated? The most reliable ECG distinguishing feature is seen in lead V6. Kaposis sarcoma and lymphoma can cause a non-infective pericarditis.Patients with the cutaneous or musculoskeletal features of rheumatoid arthritis, SLE and systemic sclerosis may be at risk of acute pericarditis relating to these diseases.This can occur early (within days) or late (months).Patients with a raised urea may have non-specific features of nausea, vomiting, anorexia and itching. Acute ischaemia is a localized process and the ST changes are restricted to the leads that record from the area deprived of oxygenated blood. The excellent diagram to the left is from the The college asked for four electrocardiographic findings suggestive of pericarditis with cardiac tamponade, rather than tamponade on its own. Patients with tuberculous pericarditis present with a less acute course. Less reliable in post-MI patients and those with baseline ECG abnormalities; PR-depression is often early and transient in pericarditis; In STEMI, PR-depression is associated with atrial injury, though usually not as marked as in viral pericarditis; PR-elevation in aVR may also be present in STEMI and is infrequently seen in constrictive pericarditis; Other Findings. LITFL has a nice example. those grainy scans reproduced below from These images are probably more interesting in their representation of pulsus paradoxus, which will be the next topic of discussion.For whatever reason, pulsus paradoxus was a dominant feature of This is also the definition seen in such sources as Of course the CICM examiner's definition as definitive as the official Scrabble dictionary. It may radiate to the arm like ischaemic pain. There may be radiological features of pneumonia if bacterial pericarditis is suspected or mass lesions indicative of neoplastic disease.CT of the chest may be performed to look for alternative diagnoses such as acute aortic dissection or pulmonary embolism.Acute pericarditis may be accompanied by some myocardial involvement. He is a contributor to a number of sites including ALiEM, LITFL, ERCast, and The SGEM. Ergo, small volumes quickly will give rise to a rapid increase in pericardial pressure, giving rise to tamponade physiology. Pericarditis is an inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4-6 weeks. He is also faculty for the Essentials of … aspirin, ibuprofen, indomethacin, etc.). Specifically, when the ST elevation (mm) to T wave height (mm) ratio is greater than 0.25 acute pericarditis is more likely than BER (Figs 2 and 3) [7].

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