Acute Pericarditis

Key points

• Features: pleuritic chest pain often relieved by sitting forwards; non-productive cough, dyspnoea, flu-like symptoms; pericardial rub; tachypnoea; tachycardia.
• Causes: viral (Coxsackie), tuberculosis, uraemia ('fibrinous' pericarditis), trauma, post-MI/Dressler's syndrome, connective tissue disease, hypothyroidism, malignancy.
• ECG: widespread 'saddle-shaped' (concave) ST elevation.
• PR depression is the most specific ECG marker for pericarditis.
• Diagnose with 2 or more of: pleuritic chest pain, pericardial rub, widespread ST elevation/PR depression, pericardial effusion. Management: an NSAID (or aspirin post-MI) PLUS colchicine (first-line, reduces recurrence) for several weeks; treat the underlying cause; echocardiography to assess for effusion/tamponade; restrict exercise until resolved.