Acute Pericarditis - Dr. Ezeamama

Pericarditis vs. MI
Your goal is not to diagnose pericarditis... it is to not miss MI.

Pericarditis = fever, position dependent pain, diffuse elevation, no reciprocal changes, no Q wave

MI = focal ST changes, reciprocal changes, Q waves, +/- pulmonary edema

{From Dr. Mattu's ECG Lessons}
Factors strongly favoring Acute MI:
-- ST Depression in any lead other than V1 or aVR
-- ST elevation that is Convex upwards (tombstone) or Slant-like/Horizontal.
-- ST elevation in III > II

If you have none of those, then consider the Factors that favor pericarditis:
-- Pronounced PR depression in multiple leads (often only seen early in viral pericarditis)
-- Friction rub

Spodick's Sign: downsloping of QRS-TP segment in 80% of acute pericarditis

When in doubt, check SERIAL ECGs!!


What to order?

- Consider troponin, CRP, WBC, ESR, CXR

- CRP can be used for diagnosis and disease monitoring


Treatment:

- NSAIDS = mainstay

- Colchicine + conventional therapy => decrease in recurrence rate in patients with a first eposide of acute pericarditis

    - dose is 0.5mg daily (<70kg) or 0.5mg BID (>70kg) x 3months (none of our cardiologists treat for that long)

Recurrent pericarditis = symptom-free for 6 weeks and then symptoms recur

Caution with Colchicine - elderly, hepatic/renal failure, pregnant patients

In refractory cases, consider steroids, chemotherapeutic agents

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