Review Question - QID 100553

The clinical presentation is characteristic of acute pericarditis. Non-radiating chest pain that is relieved by leaning forward and a scratchy rub heard on cardiac auscultation are prominent features of pericarditis.

Pericarditis is simply inflammation of the pericardium. Causes of pericardial sac inflammation include viral infections, autoimmune reactions (Dressler's syndrom or SLE), uremia, and radiation exposure. Patients will often present with difficulty breathing, recent URI symptoms, and pleuritic chest pain that is postural in nature. Patients also characteristically present with a pericardial friction rub. It is the most common clinical finding and is best heard when the patient is sitting up and leaning forward.

Tingle et. al. discuss acute pericarditis. Echocardiography can be a useful tool in ruling out cardiac tamponade as well as confirming the diagnosis of acute pericarditis. EKG changes suggestive of pericarditis are PR-segment depression and upwardly concave ST-segment elevations. Acute inflammatory markers such as CRP, ESR, and leukocyte count, are often elevated in acute pericarditis.

Markel et al. discuss pericarditis and some possible ways to prevent recurrent inflammation. Although the etiology of pericarditis is not well defined in most clinical cases, many causes have been elucidated over the years. Recurrent pericardial inflammation occurs in 15-32% of acute pericarditis cases. NSAIDs, steroids, immunosuppressive agents, and pericardiectomy have been the mainstay preventative treatments thus far. Of note, colchicine has recently been shown to be safe and effective for the treatment and prevention of recurrent pericarditis.

Illustration A depicts an EKG with the characteristic ST elevation in multiple leads that is often seen in pericarditis.

Video V illustrates what pericardial friction rub sounds like.

Incorrect answers
Answer 1: Cardiac tamponade is marked clinically by pulsus paradoxus (>10mmHg drop in blood pressure with inspiration).
Answer 2: Constrictive pericarditis can result from pericarditis. One would expect to see a positive Kussmaul's sign (raised JVP upon inspiration) and a pericardial knock.
Answer 4: Libman-Sacks endocarditis is associated with SLE and is a cause of mitral regurgitation.
Answer 5: The pain of pericarditis can mimic that of an acute myocardial infarction, except for its relief upon leaning forward.