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Pericarditis and Myocarditis for the Nurse Practitioner Licensing Exam

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Pericarditis
  • Etiology:
    • Infectious: Viral (Coxsackievirus, echovirus), bacterial (tuberculosis), fungal.
    • Non-infectious: Post-MI (acute and Dressler syndrome), autoimmune conditions (systemic lupus erythematosus, rheumatoid arthritis), uremia, malignancy, trauma.
  • Clinical Presentation:
    • Chest pain: Sharp, pleuritic, and relieved by sitting forward.
    • Pericardial friction rub: Scratchy sound on auscultation at the left sternal border.
    • Fever and dyspnea if associated with large effusion or infection.
  • Diagnosis:
    • ECG: Diffuse ST-segment elevation with PR-segment depression.
    • Echocardiography: Detects pericardial effusion or tamponade.
    • Blood tests: Elevated ESR, CRP, and sometimes leukocytosis.
  • Complications:
    • Cardiac tamponade: Hypotension, distant heart sounds, jugular venous distension (Beck’s triad).
    • Constrictive pericarditis: Chronic fibrosis causing heart failure-like symptoms.
  • Treatment:
    • NSAIDs and colchicine: First-line for inflammation.
    • Steroids: For refractory or autoimmune causes.
    • Pericardiocentesis: For tamponade or significant effusion.
    • --
Myocarditis
  • Etiology:
    • Infectious: Viral (Coxsackievirus, adenovirus), bacterial (Lyme disease), parasitic (Chagas disease).
    • Non-infectious: Autoimmune conditions (sarcoidosis), drug toxicity (e.g., chemotherapy).
  • Clinical Presentation:
    • Chest pain: Can resemble acute coronary syndrome.
    • Heart failure symptoms: Dyspnea, orthopnea, fatigue.
    • Arrhythmias: Palpitations, syncope, ventricular tachycardia.
    • Systemic symptoms: Fever, myalgias in viral myocarditis.
  • Diagnosis:
    • ECG: ST/T wave abnormalities, ventricular arrhythmias, or heart block.
    • Echocardiography: Reduced ejection fraction and ventricular dilation.
    • Cardiac MRI: Detects myocardial inflammation.
    • Blood tests: Elevated troponin and BNP.
  • Complications:
    • Heart failure, arrhythmias, dilated cardiomyopathy, and sudden cardiac death.
  • Treatment:
    • Supportive care: Diuretics, ACE inhibitors, beta-blockers.
    • Antiarrhythmic medications for arrhythmias.
    • Immunosuppressants: For autoimmune causes.
    • --
Key Points
  • Pericarditis presents with pleuritic chest pain, pericardial rub, and diffuse ST elevation. Treatment includes NSAIDs, colchicine, and pericardiocentesis if tamponade develops.
  • Myocarditis can mimic acute coronary syndrome and present with heart failure or arrhythmias. It is diagnosed using ECG, echocardiography, and cardiac MRI.
  • Key complications of pericarditis include tamponade and constrictive pericarditis, while myocarditis can cause heart failure and sudden death.