Pericarditis causes sharp precordial chest pain, worse with coughing and movement, better with leaning forward. Fever, cough, fatigue, myalgia, & arthralgia may occur. Physical findings: tachycardia, friction rub, and jugular venous distention; EKG: ST segment elevation; Echo: pericardial effusion.
CASES/YEAR
36,500 (US); 730,000 (Global)
INCUBATION
Estimated: days to weeks;
INITIAL SYMPTOMS
Sharp precordial chest pain, worse with coughing and movement and better with leaning forward; Some patients have fever, cough, fatigue, myalgia, and arthralgia. [ID, p. 590]
COMMENTS
In one series of 256 patients with pericarditis, 86% were idiopathic, 5% neoplastic, 4% tuberculous, 2% collagen vascular, 1% viral, 1% toxoplasmal, and 1% purulent. Viral is the likely etiology in most idiopathic cases. Bacterial pericarditis was common before the discovery of antibiotics. Now, most cases are complications in chronically ill patients. Tuberculosis is a major cause in developing countries and in AIDS patients. In general, viruses are seeded hematogenously while bacteria spread from contiguous infections. Signs of tamponade are hypotension, jugular venous distention, muffled heart sounds, peripheral edema, pulsus paradoxus, and tachycardia. Echocardiography can detect effusion and tamponade. Indications for pericardiocentesis: purulent effusion suspected; patient is immunocompromised; cardiac tamponade; malignancy is suspected; or, illness persists after 3 weeks and no clear etiology; [ID, p. 589-92] Cases usually present with chest pain and a pericardial rub. Tamponade with shock and pulmonary edema (interstitial infiltrates on chest x-ray) is the first indication in some cases. [Merck Manual, p. 745] Enlarged heart silhouette on chest x-ray suggest pericardial effusion of at least 200 mL. [5MCC-2020] Noninfectious causes include aortic dissection, myocardial infarction, uremia, neoplasm, radiation, rheumatologic, and drugs. [ABX Guide] Weight loss is a symptom of tuberculous pericarditis. [PPID, p. 1162] Pericardial effusion is common in patients with AIDS. Viral pericarditis is common in young adults and is often associated with pleural effusions and pneumonitis; relapses occur in about one-fourth of patients. [Harrison ID, p. 252]
DIAGNOSTIC
Physical findings: tachycardia, friction rub, and jugular venous distention; EKG: ST segment elevation; Echo: pericardial effusion; Lab: pericardial fluid Gram stain and culture; Include fungal and AFB studies; [ABX Guide]
SIGNS & SYMPTOMS
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>arthralgia
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>fatigue, weakness
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>fever
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>myalgia
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H leukocytosis
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R chest pain
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R cough
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R dyspnea
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X hilar lymphadenopathy
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X lung infiltrates
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X pleural effusions
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*pericarditis
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*pneumonitis
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*pulmonary edema
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*shock
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*weight loss
ENTRY
Inhalation, Ingestion, Needle (Includes Drug Abuse), Scalpel or Transfusion, Skin or Mucous Membranes (Includes Conjunctiva), Swimming, Sexual Contact
SOURCE
Fecally Contaminated Soil, Animal Excreta, Animal Tissue, Soil or Dust (Ingesting or Inhaling), Eating Unpasteurized Milk or Cheese, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Deer, Elk and Antelope, Dogs, Horses, Monkeys, Rabbits, Rodents, Swine, Human, Wild Animals
RISK FACTORS
- AIDS patients
- Cancer patients
TREATMENT
Colchicine should be started in all patients with acute pericarditis. [Cecil, p. 429]
REFERENCES FOR CASES/YEAR
1. (US) 0.1% among hospitalized patients; [Gorbach, p. 306] 36.5 million hospitalizations in 2011; [American Hospital Association website] 36.5 million x 0.001 = 36500;
2. (Global) 20 X US cases/yr;