Pericarditis

H&P

• Friction rub
• Fever
• Increased ESR
• Pain relieved by sitting forward
  

EKG

• Diffuse ST elevation (concave upwards) without reciprocal changes
• Diffuse PR depression in multiple leads (can be transient)
• Diffuse T-wave flattening or inversion
• T-waves do not invert in pericarditis until resolution of the ST-segment elevation, whereas in acute MI they may invert while the ST-segment remains elevated
• If the J-point elevation in V6 is > 25% of the T-wave amplitude than pericarditis is favored over BER
• PR segment elevation in Lead aVR
  

Favoring STEMI

• STD (except in V1 or aVR)
• STE in III > II
• Horizontal or convex upward STE
• Q waves that you know are new (must be a box wide and a box deep)

Diagnosis (requires two signs or symptoms)

• Chest pain
• Pericardial friction rub
• Electrocardiographic changes
• Pericardial effusion.
  

Etiology

• 80-90% - idopathic or viral (Cocksackievirus)
• 10-20% - Tb, uremia, malignancy, connective tissue disorder
  

Admission Criteria (because predict poor prognosis and need further workup)
•    Fever > 38 C
•    TnI elevated - admit because have to differentiate from myocarditis
•    Subacute onset
•    Large pericardial effusion
•    Cardiac tamponade
•    Lack of response to ASA or NSAID after at least 1 week of therapy
•    Immunosuppression
•    Trauma
•    Oral anticoagulant therapy

Treatment

• NSAID's
• Colchicine