Pericarditis

• Dressler’s syndrome

• 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

• 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

• 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure

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)

General Considerations

• Can be misdiagnosed as a heart attack
• Often the result of an infection
• No change with exertion
• Often unknown etiology

Demographics

• Mostly men ages 20 to 50 years of age

Signs and Symptoms

• Cardiac tamponade
• Sharp stabbing chest pain
• Pain can radiate into the upper trapezius muscle
• Shortness of breath
• Fatigue weakness
• Swelling in the lower extremities
• Anxiety
• Diaphoresis
• Dry cough
• Fever
• Crackles in the lungs
• Heart sounds
  • Decreased breath sounds
  • Pericardial rub sound

Functional Implications

• New York Heart Association functional status
  • Class I: a patient who is not limited with normal physical activity by symptoms
  • Class II: occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms
  • Class III: characterized by a marked limitation in normal physical activity
  • Class IV: defined by symptoms at rest or with any physical activity
• Depending on the severity
  • Decreased activity tolerance
  • Decreased exercise tolerance
  • Dyspnea on exertion
  • Hypoxia
  • Muscle weakness
  • Cardiac arrhythmia

Possible Contributing Causes1

• Infections
  • Viral infection: coxsackievirus
  • Bacterial infection: tuberculosis, purulent (staphylococcal, pneumococcal)
  • Fungal infection
  • Protozoal: ambiasis
  • Mycotic: actinomycosis, coccidiodomycosis
• Collagen vascular disease
  • Systemic lupus erythematosus
  • Scleroderma
  • Rheumatoid arthritis
• Heart attack
• Medications: tetracyclines
• Radiation
• Trauma
• Rheumatic fever
• Metabolic
  • Kidney failure
• Neoplasm: cancer
• HIV infection
• Idiopathic
• Auto-immune (Dressler’s syndrome)

• Cardiac pump dysfunction
• Angina pectoris
• Aortic dissection
• Aortic stenosis
• Gastritis
• Gastroesophageal reflux disease (GERD)
• Myocardial infarction
• Myocardial ischemia
• Pulmonary embolism

Laboratory Tests

• Antinuclear antibody (ANA)
• Complete blood count (CBC)
• C-reactive protein