emDocs EM@3AM - December 29, 2018 - Author: DeYoung H, Sulava E
Edited by: Long B
"Pericarditis is inflammation of the pericardial sac that surrounds the heart. This may be a result of infection, most commonly by a virus, however, bacteria and fungi have also been reported. Other etiologies include malignancy, drugs, uremia, or postmyocardial infarction. Pericarditis may also be idiopathic, which is thought to represent most cases. The patient typically presents with sudden or gradual chest pain that they describe as sharp or stabbing. Frequently, there is radiation to the back, neck, or left shoulder or arm. The pain may be worsened by movement or inspiration and will classically improve with sitting up and leaning forward and be made more severe by lying supine. Associated symptoms may include fevers, dyspnea, or dysphagia. A recent viral infection may also be reported. Physical exam may reveal a friction rub that is best heard at the left lower sternal border or apex. ECG findings of acute pericarditis consist of diffuse ST elevation that appears more convex in most leads. Rarely are there reciprocal changes. There is also PR segment depression. These changes are transient and therefore patients may have pericarditis without ECG changes. The diagnosis of acute pericarditis is made by the presence of two or more of the following: sharp and pleuritic chest pain, pericardial friction rub, ECG findings consistent with pericarditis, and new or worsening pericardial effusion. Additional lab tests and imaging is directed toward determining an etiology if concerns are present for causes other than idiopathic or viral pericarditis. Treatment for acute pericarditis can be outpatient, if the etiology is presumed to be viral or idiopathic and the patient is hemodynamically stable, with nonsteroidal anti-inflammatory drugs and follow-up. If other etiologies are present, then treatment will be specific to those causes and may require admission. Any patient with myocarditis, uremic pericarditis, enlarged pericardial silhouette on chest X-ray, or hemodynamic compromise requires admission."