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18: PERICARDITIS

Eric Shamus, PhD, DPT, PT, CSCS; Christopher C. Felton, DO, ATC

CONDITION/DISORDER SYNONYM

  • Dressler syndrome

ICD-9-CM CODES

  • 420 Acute pericarditis

  • 420.0 Acute pericarditis in diseases classified elsewhere

  • 420.90 Acute pericarditis, unspecified

  • 420.91 Acute idiopathic pericarditis

  • 420.99 Other acute pericarditis

  • 423 Other diseases of pericardium

  • 423.0 Hemopericardium

  • 423.1 Adhesive pericarditis

  • 423.2 Constrictive pericarditis

  • 423.3 Cardiac tamponade

  • 423.8 Other specified diseases of pericardium

  • 423.9 Unspecified disease of pericardium

ICD-10-CM CODES

  • I30 Acute pericarditis

  • I30.0 Acute nonspecific idiopathic pericarditis

  • I30.1 Infective pericarditis

  • I30.8 Other forms of acute pericarditis

  • I30.9 Acute pericarditis, unspecified

  • I31 Other diseases of pericardium

  • I31.0 Chronic adhesive pericarditis

  • I31.1 Chronic constrictive pericarditis

  • I31.4 Cardiac tamponade

  • I31.8 Other specified diseases of pericardium

  • I31.9 Disease of pericardium, unspecified

  • I32 Pericarditis in diseases classified elsewhere

PREFERRED PRACTICE PATTERN

  • 6D: Impaired Aerobic Capacity/Endurance Associated with Cardiovascular Pump Dysfunction or Failure

PATIENT PRESENTATION

A 70-year-old male presents with a recent onset of substernal chest pain. The pain is sharp and pleuritic and has started to radiate to the left trapezius muscle. Inspiration causes the pain to become more severe, but sitting up and leaning forward helps to relieve it. This patient’s review of systems reveals a recent viral illness, including “flu-like” symptoms and low-grade fever for 1 week. His past medical history is otherwise unremarkable. His current temperature is 100.9°F, BP is 130/84 mm Hg, HR is 95 bpm, RR is 24 breaths/min, and O2 Saturation is 99% in room air. Heart auscultation reveals a scratchy, rubbing sound at the lower left sternal border. Lungs are clear, but breathing is shallow. The patient is referred to the emergency room. ECG reveals widespread ST-segment elevation and chest X-ray (CXR) is normal.

FIGURE 18-1

Magnetic resonance image of cross-section of thorax showing pericardial thickening (arrows) in a patient with constrictive pericarditis. (Courtesy of C Higgins. Reproduced with permission from Sokolow M, McIlroy MB. Clinical Cardiology. 6th ed. Originally published by Appleton & Lange. Copyright © 1993 by the McGraw-Hill Companies, Inc.)

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KEY FEATURES

Description

  • Inflammation of the pericardium (fibrous sac surrounding the heart)

  • Can be acute or chronic

Essentials of Diagnosis

  • Chest pain can be relieved by sitting up and leaning forward

  • Stethoscope: Pericardial rub sound

  • Bacterial infection: Mycobacterium tuberculosis

  • Acute to chronic

    • Acute <6 weeks

    • Subacute 6 weeks to 6 months

    • Chronic >6 months

  • Classification secondary to type of fluid

    • Serous

    • Purulent

    • Fibrinous

    • Caseous

    • Hemorrhagic

    • Post infarction (from a heart attack)

FIGURE 18-2

Brachial arterial and right atrial pressures showing pulsus paradoxus in a patient with constrictive pericarditis and an increase in right atrial pressure on inspiration (Kussmaul sign). Both the systolic and diastolic atrial pressures rise with inspiration. (Redrawn with permission ...

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