Acute pericarditis
Description
- Inflammation of the pericardium, with or without effusion
Diagnostic criteria - >=2 of 4
1. Pleuritic chest pain - sharp, worse lying flat and on inspiration, relieved by sitting forward
2. Pericardial friction rub - scratchy, triphasic, best at the left sternal edge leaning forward, evanescent
3. Widespread concave ("saddle-shaped") ST elevation, or PR depression
4. New or worsening pericardial effusion
- Supporting: raised CRP/ESR, pericardial inflammation on CT or CMR
Nomenclature
| Term | Definition |
|---|---|
| Acute | First episode |
| Incessant | Symptoms continuing >4-6 weeks but <3 months without remission |
| Recurrent | New episode after a symptom-free interval of >=4-6 weeks |
| Chronic | >3 months |
Myopericarditis vs perimyocarditis
- Myopericarditis - pericarditis predominant + raised troponin, preserved LV function
- Perimyocarditis - myocardial predominant + new LV dysfunction or wall motion abnormality
- Troponin elevation occurs in ~15-30%, does not worsen prognosis in myopericarditis, but does change management: exercise restriction and avoidance of high-dose NSAIDs
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