Endocarditis, 424.90
Pericarditis, 423.9
I. Definition/general comments.
A. Acute, painful inflammation of the pericardium
B. May be mild or life-threatening
C. Accurate patient history is of paramount importance in making the diagnosis.
II. Etiology/predisposing factors/incidence.
A. Viruses: most common cause, especially infections with coxsackieviruses and echoviruses, Epstein-Barr virus, influenza, hepatitis, HIV, varicella, and mumps
B. MI: affects 10% to 15% of patients within the first week after MI
C. Higher incidence among males
D. Cardiac surgery
E. Rheumatic fever
F. Neoplasia
G. Radiation therapy
H. Uremia
I. Tuberculosis
J. Idiopathic
K. Trauma
L. Other causes, such as drug allergy or autoimmune disease
M. Acutely affects 2% to 6% of the general population
III. Subjective findings.
A. Reports of precordial/retrosternal, localized, “pleuritic” chest pain; pain that usually lasts for only a few seconds; patient may report pain under the breast
B. Pain reported as being intensified with coughing, swallowing, inspiration (patient may complain of shortness of breath), or recumbent positioning; relieved by sitting in a forward position
C. Fever may or may not be present (underlying cause).
IV. Physical examination findings.
A. Pericardial friction rub: classically heard best with the patient sitting up and leaning forward
B. Pleural friction rub may or may not be present.
C. Dyspnea
V. Laboratory/diagnostic findings.
A. ST segment elevation: ST segment returns to normal in a few days; this is followed by possible T-wave inversion.
B. Depressed PR interval: highly diagnostic of pericarditis
C. Elevated erythrocyte sedimentation rate
D. Leukocytosis
E. Consider ordering the following:
1. CBC (to rule out infection/leukemia)
2. Electrolytes
3. Blood cultures (if bacteria/infection is suspected)
4. Echocardiogram (to confirm pericardial fluid)
VI. Management.
A. Depends on underlying cause (i.e., tuberculous pericarditis or other)
B. Consider ketorolac (Toradol), 30-90 mg IV/IM; repeat with 30 mg IV/IM in 1 hour PRN for acute situations
C. Aspirin (acetylsalicylic acid [ASA]), 650 mg every 4 hours for 2 weeks or
D. NSAIDs.
1. Indomethacin (Indocin), 25-50 mg every 8 hours for 2 weeks
2. Ibuprofen (Advil, Motrin), 400-800 mg PO every 4 to 8 hours
3. Consider naproxen, 500 mg twice daily, or other NSAID.
E. Corticosteroids: indicated only after failure of high-dose NSAIDs of several weeks’ duration because corticosteroids may enhance viral replication
1. Prednisone (Deltasone), 60 mg daily
2. Then, taper and discontinue.
F. Antibiotics—as indicated for bacterial infections
G. Codeine, 15-60 mg PO 4 times a day for pain
H. Monitor patient closely for cardiac tamponade.
I. Definition.
A. Inflammation/infection of the endothelial layer of the heart, usually involving the cardiac valves
B. Endocarditis should be ruled out in any patient who presents with fever of unknown origin and a new heart murmur.
II. Etiology/incidence/predisposing factors.
A. Most commonly caused by bacteria.
1. Staphylococcus aureus
2. Streptococcus pyogenes
3. Pneumococcus
4. Neisseria organisms
B. May also be caused by fungi and viruses, especially in immunocompromised patients
C. Increased incidence associated with congenital heart disease and with valvular disease
D. Predisposing factors include recent invasive procedures such as dental surgery, genitourinary surgery, use of invasive catheters, hemodialysis, or burn treatment.
III. Subjective findings.
A. Fever lasting for several weeks
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
