Acute Pericarditis
BRIEF HISTORY
A young man presented with chest pain which was retrosternal in origin. The pain was sharp, pricking in character and aggravated while lying down, but he got a little relief while sitting up. He gave history of an upper respiratory tract infection accompanied by fever about five days ago. He was a non-smoker. There was no history of trauma, hypertension or diabetes.
IMPORTANT CLUES ON CLINICAL EXAMINATION
On examination, he looked anxious. Temperature was 102° F. Pulse was 110 per minute, regular, good volume and all pulses were palpable. Cardiovascular system revealed normal heart sounds, but there was some scratchy noise over the precordium. Both lungs were clear on auscultation. Abdominal and neurological examinations were normal.
INVESTIGATIONS
Investigations included
QUESTIONS
Q.1. What is the diagnosis?
Q.2. Give a few causes of this disease.
Q.3. What is Bornholm’s myalgia or devils grip?
Q.4. What are the complications of your final diagnosis? Q.5. What is the treatment?
Medicine
A.1.
In a young man, a history of fever, upper respiratory tract infection, retrosternal pain which is posture related with classical ECG changes point to a diagnosis of acute pericarditis.
A.2.
The causes can be as follows: Etiologic classification: a. Infective:
i. Viral ii. Pyogenic (Bacterial)
iii. Tuberculosis
iv. Mycotic
v. Parasitic.
b. Non-infective:
i. Acute myocardial infarction ii. Uremia
iii. Neoplasms,
i.e., primary or metastatic
iv. Myxoedema
v. Cholesterol
vi. Trauma
vii. Postradiation viii. Idiopathic. c. Autoimmune disorders: i. Rheumatic fever ii. Systemic lupus erythematosis
iii. Rheumatoid arthritis
iv. Scleroderma
v. Hydralazine and Procainamide
vi. Postmyocardial infarction (Dressler’s syndrome)
vii. Postpericardiotomy syndrome.
A.3.
This is an inflammation of the intercostal muscles produced by coxsackie B-5 virus and usually occurs in epidemics. This lasts for 7 to 10 days but can relapse.
A.4.
This depends on the cause. However, it can lead to pericardial effusion and then tamponade. In case of tuberculous pericarditis, fibrosis occurs leading to constrictive pericarditis. Cardiac arrhythmias may also occur.
A.5.
The treatment is according to the aetiology. However, mostly it is viral and requires no specific treatment. To get rid of the most disturbing symptom, i.e., pain, non-steroidal anti-inflammatory drugs are ideal if there is no contraindication, e.g., indomethacin in a dose of 25 mg thrice a day after meals is quite effective. If it is tuberculous, then anti-tubercular therapy is indicated. Addition of corticosteroids may be helpful to prevent any adhesions between the layers of pericardium.
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