Pericarditis

P E R I C A R D I T I S 

TODAY'S PEARLS

1. Pericarditis: classic EKG findings, diagnostic criteria & framework

2. STEMI criteria on EKG

3. Treatment of pericarditis & ICAP trial

Dr. Ryan presented a patient with a recent URI, admitted with acute-onset, left-sided, pleuritic, chest pain found to have acute pericarditis. 

EKG changes in pericarditis

Diffuse ST elevations & PR depressions

Reciprocal PR elevations/ST depressions in V1 & aVr

https://litfl.com/pericarditis-ecg-library/

Pericarditis - Diagnostic Criteria: 2 of 4 needed for diagnosis

1. Sharp, pleuritic chest pain
2. Pericardial friction rub

3. Changes on EKG

4. New or worsening pericardial effusion

~ Dr. Ryan's patient had 3/4 criteria ~ 

Dr. Ryan's patient experienced an antecedent viral URI which was likely the cause of her pericarditis. 

CAUSES OF PERICARDITIS - FRAMEWORK

From Dr. Andre Mansoor’s book, Frameworks in Internal Medicine

Why isn't this a STEMI? A brief review.

A STEMI will have ST elevations in a single coronary distribution (instead of diffusely) with reciprocal ST depressions & pathologic Q waves( > 1mm x 2mm in lead V1-3). A STEMI will not have PR depressions.

STEMI EKG Criteria (Fourth Universal Definition of MI 2018): ST elevation > 1mm in 2 contiguous leads except V2 or V3 (V2 or V3 need elevations > 1.5mm in women & 2mm in med > 40 years)

TREATMENT OF PERICARDITIS: 

Aspirin/NSAIDS +/- Colchicine (no steroids, if you can help it)

ICAP: Imazio M, et al. "A Randomized Trial of Colchicine for Acute Pericarditis". The New England Journal of Medicine. 2013. 369(16):1522-1528.

Randomized patients to colchicine vs. placebo. Patients also received ASA, NSAIDS or prednisone (ASA 71.7%, ibuprofen 20.0%, prednisone 8.3%).
Recurrent pericarditis was seen in 16.7% of patients treated with colchicine & 37.5% of patients in the placebo group.

The information posted above is for educational use only by the trainees of a non-profit hospital residency program.

Compiled by: Emma