Pericarditis

Diagnostic criteria

  • typical chest pain

  • pericardial friction rub

  • suggestive ECG changes (typically widespread ST-segment elevation, PR depression)
    +/-

  • new or worsening pericardial effusion

  • increased CRP/ESR (supports diagnosis but neither sensitive nor specific for pericarditis)

Investigations

  • cardiac auscultation

  • ECG

  • transthoracic echocardiogram (TTE)

  • ESR/CRP, CBC, creatinine, troponin, CK-MB

  • blood cultures

  • CXR

  • pericardial fluid for C&S, mycobacterial culture, and viral testing

Differential diagnosis

  • infectious (viral, bacterial, mycobacterial, fungal, parasitic)

  • non-infectious:

    • autoimmune

    • neoplastic

    • metabolic

    • traumatic

    • drug-related

Usual Pathogens
Viral (~90%):

Usually Enterovirus

 
Rare:

S. aureus/MRSA
ß-haemolytic Streptococci
S. pneumoniae
Enterobacterales
Ureaplasma spp
Mycoplasma spp
M. tuberculosis

Viral pericarditis

Empiric Therapy Dose Duration
Self-limited.    
No antiviral therapy.    

Purulent pericarditis

Empiric Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h 6 weeks
+    
Ceftriaxone 2g IV daily