Pericarditis - clinical features and management

Pericarditis is an important diagnosis to consider in a patient presenting with chest pain. It is diagnosed in 5% of patients presenting to hospital emergency departments with chest pain in the absence of a myocardial infarction.

This article describes the common features and management of pericarditis in the general practice setting.

Characteristic clinical findings in pericarditis include pleuritic chest pain and a pericardial friction rub on auscultation of the left lower sternal border. Electrocardiography may reveal diffuse PR depressions and diffuse ST segment elevations with upward concavity. The most common aetiologies of pericarditis are idiopathic and viral, and the most common treatment for these is nonsteroidal antiinflammatory drugs and colchicine. The complications of pericarditis include effusion, tamponade and myopericarditis. Pericardial effusion may present as a globular heart shadow on chest X-ray. The presence of effusion, constriction or tamponade can be confirmed on echocardiography. Tamponade is potentially life threatening and is diagnosed by the clinical findings of decreased blood pressure, elevated jugular venous pressure, muffled heart sounds on auscultation and pulsus paradoxus.