Pericarditis

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Pericarditis
Classification & external resources
ICD-10 I01.0, I09.2, I30.-I32.
ICD-9 420.90
DiseasesDB 9820
MedlinePlus 000182
eMedicine med/1781  emerg/412
MeSH C14.280.720

Pericarditis is inflammation of the sac surrounding the heart, the pericardium. Acute pericarditis is the most common form of pericarditis.

Main article: acute pericarditis

Contents

Fibrinous pericarditis is an exudative inflammation. The pericardium is infiltrated by the fibrinous exudate. This consists of fibrin strands and leukocytes. Fibrin describes an eosinophilic (pink) network, amorphous. Leukocytes (mainly, neutrophils) are found within the fibrin deposits and intrapericardic. Vascular congestion is also present. The myocardium has no changes. Photo at: Atlas of Pathology

Chest pain, radiating to the back and relieved by sitting up forward, is the classical presentation. Other symptoms of pericarditis may include dry cough, fever, fatigue and anxiety.

The classic sign of pericarditis is a pericardial rub. Other signs include ST-elevation on EKG (all leads), PR-depression and the signs of cardiac tamponade (pulsus paradoxus, hypotension) and congestive heart failure (elevated jugular venous pressure, peripheral edema).

Pericarditis caused by tuberculosis is difficult to diagnose, because it involves culturing Mycobacterium tuberculosis from aspirated pericardial fluid or pericardial biopsy, which requires high technical skill and is often not diagnostic (the yield from culture is low even with optimum specimens). The Tygerberg scoring system helps the clinician to decide whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point), fever (2 point), serum globulin >40g/l (3 points), blood total leucocyte count <10 x 109/l (3 points); a total score of 6 or more is highly suggestive of tuberculous pericarditis.[1] Pericardial fluid with an interferon-γ level greated than 50pg/ml is highly specific for tuberculous pericarditis.

Complications may include:

The treatment in viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs. Severe cases may require:

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