Pericarditis is an inflammation of the parietal or visceral layers of the heart. It has many causes, can mimic many conditions, and requires early diagnosis for prompt treatment in order to avoid long term sequelae.
How does it present?
Sharp/pleuritic chest pain
Radiates to back or shoulders
Better leaning forward and worse when lying flat
Associated with fever, chills, malaise
What will you find on exam?
What are the criteria for diagnosis?
You need 2/4…AKA 2/3
** REALIZE THIS LOOKS LIKE MI WHICH IS THE CANNOT MISS DIAGNOSIS
What can cause it?
Infectious: Viral, Bacterial (TB), Fungal, Parasitic,
Toxic: Medications, Uremia
Systemic Diseases: SLE, RA, Sarcoidosis, Amyloidosis, Dermatomyositis, Cancer (Lung, Breast, Lymphoma, Leukemia)
Injury: MI, Trauma, Radiation, Surgery
Other: Aortic Dissection
Who should be admitted?
High risk criteria:
What is the best outpatient treatment regimen?
If you think it’s viral or idiopathic (majority of cases), NSAIDs and Colchicine together and remember GI prophylaxis:
What about ‘Roids?!
Steroids are associated with higher rate of recurrence
Reserved for people with contraindications to NSAIDs
Or for people with systemic inflammatory processes, pregnancy, renal failure
Dose: 0.2 - 0.5mg/kg/day for 2 weeks and then tapering over 3 months
Are there any special considerations/ exceptions to the standard regimen?
Post MI pericarditis give aspirin and colchicine b/c any other NSAIDs inhibits scar formation
NSAIDs and aspirin alter vitamin K antagonist metabolism (which is why we admit these patients)
Won’t aspirin or NSAIDs increase risk of bleeding into pericardial space causing hemorrhagic pericardial tamponade?
What’s your point?
Don’t forget your troponins
Remember to do a bedside echo
Rule out MI before settling on pericarditis and scrutinize the EKG
Know who to admit and who you can send home
NSAIDs + colchicine and remember PPI - Treatment requires long course
Only specific cases need ‘Roids
Arman Sobhani, MD is a current third year resident at Stony Brook Emergency Medicine.
Edited by Bassam Zahid, MD