Today we discussed prognostic tools for pneumonia - the PORT and CURB65 scores. You can read more about these here.
As part of our differential diagnosis of Chest Pain, the topic of pericarditis came up.
Clinical presentation: usually a sudden onset of retrosternal chest pain with a pleuritic component to it, often relieved by sitting up. You may hear a pericardial rub - this is classically described as a triphasic, high-pitched sound. The 'tri' refers to:
It may be a transient phenomenon so listen again if you don't hear it. Classic situation...you hear the pericardial rub, admit and treat the patient. When your attending reviews the case the next morning they can't hear it - even though you swear on your life that you heard one. Solution: when you hear a pericardial rub, get your friend to have a listen as well, so in the morning both of you can say you heard it.
- atrial systole
- ventricular systole
- ventricular diastole
It may be a transient phenomenon so listen again if you don't hear it. Classic situation...you hear the pericardial rub, admit and treat the patient. When your attending reviews the case the next morning they can't hear it - even though you swear on your life that you heard one. Solution: when you hear a pericardial rub, get your friend to have a listen as well, so in the morning both of you can say you heard it.
ECG: may show diffuse, concave ST elevations that do not fit any particular vascular territory. PR depression is also seen. Check out the ECG above.
Treatment: In most cases of idiopathic pericarditis, high dose NSAIDS are effective. Steroids and colchicine also may have a role. Interestingly, newer evidence suggests that colchicine may be a good first line agent. Here is a link to the article published in Circulation. Have a look and decide for yourself.
Other Links:
- We discussed the causes of pericarditis previously
- A great review article on pericarditis from NEJM can be found here.
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