Warning:
• Any pericarditis may be complicated by tamponade.
• Viral acute pericarditis may recur in the short term.
• Link to aspirin or anti-inflammatory oral gastric protector.
Clinic:
– Prolonged chest pain, continuous, non triggered by stress, increased by deep inspiration or supine, relieved by sitting insensitive nitroglycerin.
– Moderate dyspnea.
– Background influenza in previous days, fever.
– The research review, besides the pathognomonic pericardial friction, signs of poor tolerance +++ significant dyspnea, signs of right heart failure (jugular distension, reflux), paradoxical pulse decreasing amplitude on inspiration.
– Signs directing to a non-viral cause (pleurisy, cancer …).
Electrocardiogram:
– Deputy offset PQ, concave diffuse STEMI top of ST without mirror image, microvoltage standard, electric alternating (variable amplitude of QRS).
– Sometimes atrial rhythm disorders like AC / FA.
– Evolution: Return to the isoelectric line ST, flattening then negativation T.
– Standardization may take several months.
CXR:
– Normal if small effusion, it serves primarily to seek an associated anomaly (lymphadenopathy, pleural disease).
– In large effusions, silhouette carafe or teapot.
Echocardiography:
– Positive diagnosis of Clef (with inflammatory syndrome)
– If small effusion, sometimes difficult differential diagnosis of pericardial fat fringes (potential utility of CT or MRI).
– Acknowledged fault if dry pericarditis.
– It must be repeated consideration during the development +++.
Etiological:
– Viral pericarditis: context of epidemic viral disease, favorable aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
– Other causes are diagnosed by appropriate investigations: tuberculin skin test, radios, CT scan, looking for a connectivity …
Order No. 1: acute viral pericarditis
– Rest and work stoppage.
– ASPEGIC 1000 [DL acetylsalicylate] or PH 8: 3 times daily with meals, or SURGAM [tiaprofenic acid] 3-6 tab daily.
– Possibly associated CYTOTEC [misoprostol] 2 tablets per day, or omeprazole 20mg daily.
Ordinance No. 2: Trailing acute pericarditis
– Specialized reviews.
– Corticosteroids will be considered after formally eliminated other causes.
No.3: poorly tolerated pericarditis, tamponade
– Hospitalization in emergency surgical drainage or puncture under ultrasound.
– Positive inotropic drugs and intravenous fluids.
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