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Pericarditis, Emergency Medicine

Terrance T. Lee and Shamai A. Grossman Reviewed 06/2017
 


Basics

Description

  • Inflammation, infection, or infiltration of the pericardial sac surrounding the heart:

    • Pericardial effusion may or may not be present.

  • Acute pericarditis:

    • Rapid in onset

    • Potentially comp...

Diagnosis

Signs and Symptoms

  • Chest pain

  • Fever

  • Mild dyspnea

  • Cough

  • Hoarseness

  • Nausea

  • Anorexia

History

  • Chest pain:

    • Pain radiating to the ridge of the trapezius from phrenic irritation

    • Central or substernal pain

    • Sudd...

Treatment

Pre-Hospital

  • ABCs, IV access, O2, monitor

  • Consider fluid bolus if no crackles.

Initial Stabilization/Therapy

  • ABCs

  • Emergent pericardiocentesis:

    • For hemodynamic compromise secondary to cardiac tampo...

Follow-Up

Disposition

Admission Criteria

  • ICU:

    • Hemodynamic instability

    • Cardiac tamponade

    • Malignant dysrhythmia

    • Status postpericardiocentesis

  • Telemetry unit:

    • Suspicion of myocardial infarction

    • Severe pain

    • Suspici...

Pearls and Pitfalls

  • Classic history: Viral illness preceding development of sharp, positional chest pain

  • Rub is very specific but not always audible.

  • The challenge is distinguishing pericarditis from ac...

Additional Reading

  • Imazio  M, Adler  Y. Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev.  2013;18(3):355–360.

  • Maisch  B, Seferovi...

Codes

ICD9

  • 420.90 Acute pericarditis, unspecified

  • 420.91 Acute idiopathic pericarditis

  • 423.2 Constrictive pericarditis

  • 420.0 Acute pericarditis in diseases classified elsewhere

  • 017.90 Tuberculosis of other...

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