Pericarditis

Classic findings:

1. Chest pain (sharp and severe) with pleuritic component
2. Pericardial Friction Rub hear on auscultation
3. Diffuse concave ST segment elevation on ECG, with PR segment depression
4. Pericardial effusion (present in 60% of patients)
5. Fever and elevated inflammatory markers

Worse in recumbent position

Differentials to consider: Acute MI, PE, Aortic dissection

Causes:

Idiopathic
- Presumed viral or autoimmune - 40% of all cases 

Infection
- Post viral: Coxsackie A and B, Echovirus, Adenovirus HIS, Hep B+C
- Bacterial - Staph, Strep, Haemophilus, pneumococcus
- Mycobacterium TB
- Fungi: Histoplasma, Aspergillus, Candida

Autoimmune
- Rheumatic disease: SLE, RA, scleroderma
- Others: UC, GCA, PAN

Radiation
- Thoracic radiation: occurs 5 months post exposure usually

Myocardial Infarction Related
- Acute MI - 1-3 days post acute MI (usually ST elevation type)
- Dressler Syndrome - occurs several weeks/months post MI

Neoplasm
- Lung/breast/lymphoma, leukaemia

Cardiac Injury
- After blunt and penetrating trauma: may develop tamponade
- Post pericardiotomy
- Iatrogenic: post catheter insertion

Medications
- Antiarrhythmics: Procainamide, amiodarone
- Antihypertensives: hydralazine
- Antibiotics: Penicillin
- Chemo: Doxorubicin, daunorubicin

Metabolic disorders
- Uraemic

Aortic disease
- Thoracic aortic pathology causing leaking or rupture into pericardial space

Other
- Radiofrequency catheter ablation of atrial fibrillation
- Takotsubo CM

Myopericarditis

• Occurs in 15% of patients with pericarditis
• ECG shows regional concave downward ST segment elevation
• ECHO shows new segmental or global left ventricular dysfunction
• Elevated cardiac markers

Treatment:

Identify and treat underlying cause if possible

Pain relief

Prevention of tamponade and constrictive pericarditis and recurrence

1) Aspirin or NSAIDs + PPI protection - Caution post MI (use aspirin as NSAIDs promote ventricular rupture). 

2) Colchicine added in refractory cases (COPE trial supports concurrent use with above from start)

3) Steroids