Pericarditis

Background

Inflammation of the pericardial sac
Can be classified as acute (lasting up to 6 weeks), recurrent (symptom-free interval of 4- 6 weeks), chronic (lasting more than 3 months

Idiopathic (most common): thought to be viral or post-viral
Infectious: viral (Coxsackievirus, adenovirus, COVID-19, EBV, parvovirus B19), bacterial (TB, staph, strep), fungal
Malignancy: metastasis from primary cancer (lung, breast, lymphoma), complication of radiation or chemo, immune checkpoint inhibitor-associated
Autoimmune: SLE (most common), RA, hypothyroidism, systemic sclerosis, MCTD, Sjogren’s syndrome, myositis, vasculitides, sarcoidosis
Cardiac: Infarction (Dressler syndrome), myocarditis, post pericardiotomy syndrome
Other: Trauma (including procedures), metabolic (uremia), drug-induced

Chest pain –sharp, substernal, acute, and improved by sitting and leaning forward
Pericardial friction rub at left sternal border
ECG changes: typically diffuse ST elevations and PR depression - Chest pain almost always present. Pericardial rub highly specific. - Even small effusion can help confirm diagnosis, but lack thereof does not rule it out
Chest pain almost always present. Pericardial rub highly specific.
Even small effusion can help confirm diagnosis, but lack thereof does not rule it out

Always: EKG, chest x-ray, BMP, CBC, troponin, ESR, CRP and TTE
- TTE should be performed ASAP if tamponade suspected
In select populations if warranted: Blood cultures, ANA, RF, anti-CCP, PPD, chest CT

Ibuprofen 600-800mg TID (1-2 wks, based on symptom resolution and normalization of CRP) + colchicine 0.6mg BID (3 months for acute, 6 months for recurrent)
If recent MI, aspirin 650-1000mg TID (1-2 wks) + colchicine
If not responding to ibuprofen, indomethacin 50mg TID (1-2 wks) + colchicine
If NSAIDs are contraindicated, prednisone 0.2-0.5mg/kg daily for 2 weeks followed by taper + colchicine
Advise patient to avoid strenuous activity since exercise-induced tachycardia may increase inflammation