The thoracic pain of pericarditis is often intense and sudden onset. The pain is
acute, increases with the inspiration and the movement of the trunk and can be
relieved by bending forward.
This type of pain may be due, at least in part, to often concomitant pleurisy.
Together with this puncture pain, you can have a sense of pressure or deep pain
that is sometimes radiated to the neck, arms and back.
Pain can be accentuated by swallowing or coughing, whereas it is usually not affected by stress.
Particularly characteristic, but less frequent, is intermittent pain that
appears with every heartbeat.
Careful medical history can be useful in determining the etiology of
pericarditis. A very common form of idiopathic or viral pericarditis is usually
preceded by an infection of the upper airways, while tuberculous pericarditis is
preceded by an old history (at least a few months) of asthenia, fever and weight
loss.
Postinfectional pericarditis or Dressler's syndrome is primarily related to a
recent transmural myocardial infarction, although sometimes this morbid event
has not been clinically recognized.
On the basis of the anamnesis, other etiological motives such as uremia, lupus
erythematosus, traumas, neoplasms or radiation syndrome may also be suspected.
At the physical examination, pericardial rubbing is characteristically found.
This gross noise has three components: presystolic (atrial systole), systolic
and diastolic, and one or all of these components may be present.
In general, rubbing is best heard at the end of exhalation with the patient in a
sitting position.
Rubbing can be reduced in intensity or disappear when the pericardial sheets
are separated from one another by a spill.
- Trauma: pericardiotomy, injection of m.d.c., perforations of the right
ventricle from the catheter, pacemarker implantation, stroke on the thorax;
- Viral infections: coxackie virus, adenovirus, infectious mononucleosis,
influenza, venereal lymphogranuloma, mycoplasma, AIDS;
- bacterial infections: TB, staphylococcal, pneumococcal, meningococcal,
streptococcal, from haemophilus influenzae, chlamydiae,
rickettia
- fungi, histoplasm, aspergillus, amyloidosis
- Radiation
- Primitive tumors: mesothelioma, teratoma, fibroma, leiomyofibroma, lipoma
- Metastasis: bronchogenic carcinoma, breast carcinoma, lymphoma, leukemia,
melanoma.
- Granulomatosis: diseases of collagen, rheumatic fever, SLE, vasculitis,
scleroderma;
- Anticoagulants: heparin and dicumarolics
- Myocardial infarction or Dressler's syndrome
- Drugs: procainamide, disodiocromoglicate, hydralazine, dantrolene
- Dissecting aneurysm
- Hemopericardium
- Hydro pericardium.
- Chilo pericardio
With pericarditis, chest pain and rubbing appear simultaneously, in contrast to
acute myocardial infarction in which a rubbing usually follows the onset of
chest pain by hours or days.
The objective findings found in cases of large pericardial or pericardial
constricting syndrome are represented by the sign of Ewart (a small area of hypophonesis,
bronchial breath and tactile tremor increased near the angle of the left
shoulder blade due to compression of the base of the left lung), inspiratory
turgor of the veins of the neck and paradoxical pulse.
In acute pericarditis, the electrocardiogram usually shows an elevation of the
ST segment. This finding is found in most of the derivations, with the exception
of the AVR and the VI, in which we often have specular sub-levels. During acute
pericarditis, the amplitude and shape of the T wave are usually unchanged and
the elevated ST tract is concave, whereas in acute myocardial infarction T waves
can be isoelectric or inverted and the ST segment appears convex.