Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acute Pericarditis 49

differential diagnosis

■idiopathic

■infectious (viral, bacterial, fungal, protozoal)

■neoplastic (primary mesothelioma; metastatic breast, lung, mela-

noma, lymphoma)

■inflammatory (connective tissue disease, Dressler’s syndrome, post-

radiation)

■traumatic (blunt trauma, iatrogenic, e.g., cardiac surgery)

■metabolic (uremia, myxedema)

■medications (hydralazine, procainamide, isoniazide, anticoagu-

lants)

■congenital (pericardial or thymic cysts)

■other (aortic dissection, amyloid, sarcoid, familial Mediterranean

fever)

management

What to Do First

■assess for clinical evidence of tamponade

➣(elevated neck veins, pulsus paradoxus either palpable or >10–15

mm Hg by blood pressure cuff, hypotension)

General Measures

■symptomatic relief with NSAIDs

■some patients may require steroids

■avoid anticoagulation

specific therapy

■for bacterial pericarditis: IV antibiotics

■for tuberculous pericarditis: start 4-drug anti-TB therapy

■for neoplastic pericarditis: chemotherapy against underlying malig-

nancy

■for uremic pericarditis: dialysis

follow-up

■during treatment, regularly assess for development of new pericar-

dial effusion/tamponade

complications and prognosis

Complications

■60% develop pericardial effusion

■<10% develop tamponade or constrictive pericarditis

Prognosis

■largely depends on underlying etiology