If pericarditis remains active for a week or more, a TB
skin test is indicated and three samples of sputum or
ACUTE PERICARDITIS gastric washings should be examined and cultured
History for tuberculosis.
TB pericarditis often progresses rapidly to effusive-
1) Chest pain
constrictive or constrictive pericarditis.
2) Pleuritic PNA or pulmonary infarction.
Diagnosis with PCR to identify TB in pericardial fluid,
3) Pericardial Characteristic radiation of pericardial
and adenosine deaminase activity helps indicate the
pain is to the shoulder (the trapezius ridge.) Pt finds
probability of TB.
relief by sitting up, and reports worsening of the
Regrettably, a number of patients are treated on
pain with inspiration.
presumptive evidence such as a recent conversion of
4) Dysphagia sometimes accompanies pericardial pain.
the skin test and known contact with the disease.
AIDS presents a whole new subset of patients who
6) Pericardial friction rub (rub may come and go)
may develop TB or other varieties of pericarditis
Differential diagnosis because of their immunosuppression.
1) AMI Pericardiocentesis:
2) dissecting aorta
Effusions should be drained. Cardiac tamponade is an
3) pulmonary embolism
unequivocal indication for pericardiocentesis. If
4) number of thoracic and abdominal catastrophes
pericarditis remains active or the effusion persists
Causes for three or four weeks, pericardial biopsy should be
Any clue on history, PE or routine labs suggesting a done. Pericardiocentesis is frequently followed
systemic disorder as the cause of pericarditis must after several weeks by pericardiectomy because of
be followed up. the likelihood that the patient has by that stage
1) Inflammatory illness flu-like illness and fever. developed effusive-constrictive pericarditis and to
Sudden onset. Viral infection: Most common prevent chronic constrictive pericarditis. Whether
etiology of acute pericarditis adding prednisone to the treatment of acute
2) Collagen vascular disorders tuberculosis pericarditis prevents subsequent
3) Drugs such as procainamide constriction.
4) Trauma or prior MI (Dressler’s syndrome)
5) Cardiac surgery (post-pericardiotomy syndrome)
6) Renal failure
7) Bacterial and other infections
8) Trauma and aortic dissection.
9) After radiation.
Lab evaluation: electrolytes, BUN, CBC (leukocytosis),
sed rate, CXR, and ECG.
Do further testing only to follow specific clues, or when
the clinical course is atypical.
Echo: useful for confirming the diagnosis when it shows
even a small pericardial effusion, but absence of
effusion by no means excludes the diagnosis.
Bed rest, symptomatic treatment of pain, and careful
monitoring for development of hemodynamic
NSAIDS indocin. Can use ibuprofen. In some pts
cholchicine works well as monotherapy or as add on
Steroids: Used only if required for a specific illness such
as a connective tissue dz or as the last resort
One of the most difficult cardiac problems that internists
may have to face. What at first appeared to be a
simple case of idiopathic or viral acute pericarditis
may, after apparent cure, recur on multiple
occasions over a period of months or even years.
The same phenomenon may follow acute effusive
pericarditis, Dressler’s syndrome, post-traumatic
pericarditis, and the post-pericardiotomy syndrome.
Recurrences respond to prednisone, but because of its
unwanted effects and because some patients become
dependent on it, every effort should be made to
avoid or minimize its use.
Uncommon in the United States.
Does not have a characteristic clinical course.
5 % of pts w/apparent idiopathic pericarditis are
subsequently found to have TB pericarditis
TB must be considered a diagnostic possibility in all
cases of pericarditis, acute or chronic.
If pericarditis resolves within a week, either
spontaneously or in response to simple anti-
inflammatory treatment, tuberculosis is very
TB pericarditis may be dry or effusive at presentation.