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[[Pericarditis]] is a condition in which the sac-like covering surrounding the heart (the [[pericardium]]) becomes inflamed. Symptoms of [[pericarditis]] include [[chest pain]] which increases with deep breathing and lying flat.
==Epidemiology and Demographics==
Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections. [[Pericarditis]] in developed countries are usually due to viral infections such as [[echovirus]] and [[coxsackie virus]], while in developing countries it is usually secondary to [[tuberculosis]] or [[HIV]] infection. The incidence of pericarditis following [[MI]] has greatly reduced with the use of early [[thrombolytic]] agents and revascularization.
==Natural History, Complications and Prognosis==
Pericarditis is often self-limited and most people recover in 2 weeks to 3 months. However, the condition can be complicated by significant fluid buildup around the heart (a [[pericardial effusion]] or [[cardiac tamponade]]) and may require urgent intervention including [[pericardiocentesis]].  If scarring of the sac around the heart (the [[pericardium]]) occurs, then this is called [[constrictive pericarditis]] which may require surgical stripping of the scar.
Pericarditis is usually a complication of viral infections, most commonly [[echovirus]] or [[coxsackie virus]].  In addition, pericarditis can be associated with diseases such as [[autoimmune disorders]], cancer, [[hypothyroidism]], and [[kidney failure]].  Often the cause of [[pericarditis]] remains unknown, or idiopathic.
===Physical Examination===
A careful physical examination must be performed to exclude the presence of [[cardiac tamponade]], a dangerous complication of pericarditis.  If [[cardiac tamponade]] is present, then [[pulsus paradoxus]], [[hypotension]], an elevated [[jugular venous pressure]] and [[peripheral edema]] may be present.
In the presence of a large effusion or tamponade, there may be diminished voltage and [[electrical alternans]] (alternation of [[QRS complex]] amplitude or axis between beats).
Echocardiographys is generally performed to assess for the presence of a [[pericardial effusion]] and to assess and monitor its size. Echocardiography is critical in confirming the clinical suspicion [[cardiac tamponade]]. 
In cases that are thought to be due to viral pericarditis, treatment includes [[aspirin]] or a [[nonsteroidal anti-inflammatory drug (NSAID)]] such as [[ibuprofen]] for inflammation of the [[pericardium]]. [[Corticosteroids]] such as [[prednisone]] and / or [[Colchicine]] may be be necessary in refractory cases. [[Diuretics]] may be prescribed to remove excess fluid in the [[pericardial sac]].
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Mature chapter]]
[[Category:Up-To-Date cardiology]]

Latest revision as of 17:01, 24 May 2021