I have seen a fair few patients that I have diagnosed with pericarditis. It seems that I've probably over-diagnosed it in quite a lot of people! 5% of patients presenting to the ED with non-ischaemic chest pain have acute pericarditis - so my numbers are probably right.
- Relieved by leaning forward
- Can radiate to the trapezius ridge as the phrenic nerve travels
- Pericardial friction rub in 85% of cases
- Rub still heard on breath holding
- Diffuse concave or saddle shaped ST changes, with ST elevation in 90% of cases, typically leads Ι, ΙΙ, V5 and V6
- Associated ST depression in aVR and V1 is seen in 64% of cases .
- PR depression
- Look carefuly at V6. If ST elevation to T wave height ratio is greater than 0.25, acute pericarditis is more likely than BER.
Diagnosis - needs 2/4
Characteristic chest pain
Pericardial friction rub
Suggestive ECG changes
New or worsening pericardial effusion
High Risk features
Temperature greater than 38ºC
Large pericardial effusion
Failure of NSAID therapy
Troponin levels are elevated in 30-70% of patients with 'pericarditis'; they offer no prognostic information.
A true diagnosis needs relief of symptoms from pericardiocentesis.
Signs - Pulsus paradoxus is an exaggerated fall in systolic blood pressure of 10 mmHg or more during inspiration.
The Beck triad is present in only a minority of patients