Acute pericarditis is a condition referring to inflammation of the pericardial sac, lasting for less than 4-6 weeks.

Aetiology

• viral infections (Coxsackie)
• tuberculosis
• uraemia
• post-myocardial infarction
  • early (1-3 days): fibrinous pericarditis
  • late (weeks to months): autoimmune pericarditis (Dressler's syndrome)
• radiotherapy
• connective tissue disease
  • systemic lupus erythematosus
  • rheumatoid arthritis
• hypothyroidism
• malignancy
  • lung cancer
  • breast cancer
• trauma

Features

• chest pain: may be pleuritic. Is often relieved by sitting forwards
• other symptoms include a non-productive cough, dyspnoea and flu-like symptoms
• pericardial rub

Investigations

• ECG changes
  • the changes in pericarditis are often global/widespread, as opposed to the 'territories' seen in ischaemic events
  • 'saddle-shaped' ST elevation
  • PR depression: most specific ECG marker for pericarditis
• all patients with suspected acute pericarditis should have transthoracic echocardiography
• bloods
  • inflammatory markers
  • troponin: around 30% of patients may have an elevated troponin - this indicates possible myopericarditis

ECG showing pericarditis. Note the widespread nature of the ST elevation and the PR depression- e Image used on license from Dr Smith, University of Minnesota