0071643192.pdf

TREATMENT

■ Treat underlying etiology.
■ ASA or NSAIDs for anti-inflammatory effects and pain control
■ Narcotics for intractable pain
■ Steroids in patients with ongoing symptoms after infectious etiology excluded
■ Mild cases attributed to viral origin can usually be managed as outpatients.

COMPLICATIONS

■ Pericardial tamponade
■ Constrictive pericarditis
■ Fibrotic change reduces diastolic filling.
■ Kussmaul’s sign: increase in JVP during inspiration
■ “Dip and plateau” LV filling (or diastolic) tracing

Pericardial Effusion and Tamponade

While cardiac tamponade results from a pericardial effusion, not all effusions
cause tamponade. An effusion that develops slowly allows for the pericardium
to stretch and the LV volume to increase in response to the fluid, decreasing
the likelihood of tamponade.

CARDIOVASCULAR EMERGENCIES

FIGURE 2.14. Pericarditis with ST elevation in multiple regions.

(Reproduced, with permission, from Fuster V, Alexander RW, O’Rourke, RA. Hurst’s The Heart, 12th ed. New York: McGraw-Hill,
2008:303.)

Steroids are used in chronic

pericarditis and in patients

who cannot tolerate NSAIDs.

TABLE 2.13. Progression of ECG Changes in Acute Pericarditis

ECG in Acute Pericarditis

Stage 1 PR depression and diffuse ST elevation

Stage 2 ST and PR normalize, T waves flatten

Stage 3 Diffuse T-wave inversion

Stage 4 Returns to normal