Overview
Definition
Inflammation of the pericardial sac surrounding the heart.
Epidemiology
The most common disorder of the pericardium. More common in men.
Etiology & Risk Factors
- Idiopathic (presumed viral - most common)
- Viral (Coxsackie, Echovirus)
- Post-MI (Dressler syndrome)
- Uremia
- Autoimmune (Lupus, RA)
Clinical Symptoms
- Pleuritic chest pain (sharp, worse with deep breathing)
- Pain improves when sitting up and leaning forward
- Fever
Clinical Approach
Diagnosis
- Requires 2 of 4: (1) Classic chest pain, (2) Pericardial friction rub, (3) Widespread ST elevation on ECG, (4) New/worsening pericardial effusion
- ECG: Diffuse ST-segment elevations and PR-segment depressions
Management
- NSAIDs (Ibuprofen or Indomethacin) + Colchicine (first-line)
- Steroids ONLY if NSAIDs/Colchicine contraindicated or in specific immune-mediated cases (increases recurrence risk otherwise)
- Targeted therapy for specific causes (e.g., Dialysis for uremic)
Complications
- Pericardial effusion
- Cardiac tamponade
- Constrictive pericarditis (chronic)