Expansion
Two of four features: pain, rub, ECG changes, effusion
Expansion
Diagnosis requires two of four:
- Chest pain: sharp, pleuritic, worse lying flat and relieved by sitting forward
- Pericardial friction rub
- ECG changes: widespread saddle shaped ST elevation with PR depression, and PR elevation in aVR
- Pericardial effusion
“Widespread and saddle shaped, with PR depression” is the whole ECG distinction from infarction, where ST elevation is territorial, convex, and has reciprocal depression.
Causes
- Viral and idiopathic, much the commonest: Coxsackie, echovirus
- Bacterial, including tuberculosis
- Post myocardial infarction: early (within days) or Dressler’s syndrome at 2 to 6 weeks, an autoimmune reaction
- Uraemia
- Autoimmune: lupus, rheumatoid
- Malignancy, radiotherapy, trauma, drugs
Treatment is NSAID or aspirin plus colchicine, colchicine markedly reducing recurrence. Steroids are avoided unless there is a specific indication, since they increase recurrence.
Aspirin rather than an NSAID after myocardial infarction, since NSAIDs impair infarct healing.