0071643192.pdf

■ Medications

■ Procainamide

■ Hydralazine

■ INH

■ Systemic diseases

■ SLE

■ Scleroderma

■ Rheumatic fever

■ Post MI (2–10 weeks): Dressler syndrome

■ Malignancy

■ Uremia

■ Posttraumatic

PATHOPHYSIOLOGY

■ Inflammation of pericardium →pericardial thickening and effusion

SYMPTOMS

■ Substernal chest pain

■ Exacerbated by deep inspiration

■ Relieved by leaning forward

■ Radiation to the trapezius sometimes seen

■ Fatigue

■ Intermittent fever

EXAM

■ Pericardial friction rub=classic finding

■ Auscultate with patient leaning forward.

■ Biphasic and “scratchy,” best at left sternal border

DIFFERENTIAL

■ Myocarditis

■ Acute coronary syndrome

■ PR depression is seen in atrial infarction.

■ If ST elevation present, look for regional distribution and reciprocal T

wave inversions (not seen in pericarditis).

DIAGNOSIS

■ Suspect in any patient presenting with chest pain and fever (although

fever is not a necessary finding)

■ ECG (see Table 2.13 and Figure 2.14)

■ Stage 1 (first hours to days): PR depression and diffuse (except aVR, V 1 )

ST elevation with concave up segments

■ Stage 2: ST and PR segments normalize, T waves flatten

■ Stage 3: Diffuse T-wave inversions

■ Stage 4: Returns to normal

■ CXR: Usually nonspecific, but may show cardiomegaly if a pericardial effu-

sion is present

■ Echocardiogram: To evaluate for pericardial effusion and tamponade (see

below)

■ Laboratory studies: Expect leukocytosis, ESR, cardiac enzymes, BUN/Cr

(if uremic etiology)

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CARDIOVASCULAR EMERGENCIES

The chest pain of pericarditis

is characteristically

exacerbated by deep

inspiration and relieved by

leaning forward.

Hallmark of pericarditis =

pericardial friction rub

PR depression is specific for

pericarditis.