Troponin elevated in 32-49% of patients with acute idiopathic pericarditis
Features associated with + Tn:
Younger age
Male
Pericardial effusion
Recent infection
ST segment elevations
Evolution of EKG changes
Acute phase: ST elevations and PR depression
Normalization of ST and PR segments
Diffuse T wave inversions
T wave inversions may persist or normalize
EKG Changes
ST elevation begins at J-point
Rarely greater than 5 mm
Usually remains concave
ST depression absent
ST elevation and T wave inversion don’t occur together
PR depression due to atrial current of injury
No hyperacute T waves or Q waves
Diagnostic Workup
ECG
CXR
PPD
ANA if appropriate
HIV
Blood cultures if febrile
Echo
All patients with suspected pericardial disease
ACC/AHA/ASE Class I recommendation
Finding of an effusion is helpful in making the diagnosis
Absence of effusion does not rule out dx
Helpful in diagnosis of purulent pericarditis, myocarditis or ruling out MI
Hospital Admission
Subacute symptoms
High fever (>38ºC) and leukocytosis
Evidence suggesting tamponade
Large pericardial effusion (> 20 mm)
Immunosuppressed state
Coumadin
Acute trauma
Failure to respond to NSAIDs in 7 days
Treatment
ASA or NSAIDS
ESC recommends ibuprofen
Ibuprofen: 400-800mg Q6-8 hrs
Aspirin: 800mg Q6-8 hrs
May need to treat as long as 3-4 weeks
Colchicine
COPE trial
Open-label randomized trial:
120 pts with 1st episode acute pericarditis
ASA or ASA plus Colchicine for 3-4 weeks
Colchicine dosing: 2mg x 1, then 0.5mg BID
Colchicine group:
Significantly lower recurrence rate (10.7% v 32.3%) and rate of persistent sx at 72 hrs (11.7% v 36.7%)
Steroids
Should only be considered if sx refractory to NSAIDS or colchicine
Associated with recurrence of symptoms
2004 ESC guidelines:
Acute pericarditis due to connective tissue disease
Autoreactive (immune-mediated) pericarditis
Uremic pericarditis
References
Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R. Colchicine in addition to conventional therapy for acute pericarditis: results of the COPE trial. Circulation. 2005; 112: 2012–2016
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