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Pericarditis and Myocarditis for the Physician Assistant Licensing Exam

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Pericarditis
  • Etiology:
    • Infectious: Viral (Coxsackievirus, echovirus), bacterial (tuberculosis), fungal.
    • Non-infectious: Post-MI (acute and Dressler syndrome), autoimmune (lupus, rheumatoid arthritis), uremia, malignancy, trauma, radiation.
  • Clinical Presentation:
    • Chest pain: Sharp, worsens with inspiration, relieved by sitting upright and leaning forward.
    • Pericardial friction rub: Scratchy sound heard on auscultation.
    • Fever and dyspnea with large effusion.
  • Diagnosis:
    • ECG: Diffuse ST-segment elevation with PR-segment depression.
    • Echocardiography: Detects pericardial effusion and signs of tamponade.
    • Lab findings: Elevated ESR, CRP.
  • Complications:
    • Cardiac tamponade: Hypotension, distant heart sounds, jugular venous distention (Beck’s triad).
    • Constrictive pericarditis: Chronic scarring impairs diastolic filling.
  • Treatment:
    • NSAIDs and colchicine: First-line therapy.
    • Steroids: For autoimmune or refractory cases.
    • Pericardiocentesis: For tamponade or significant effusion.
    • --
Myocarditis
  • Etiology:
    • Infectious: Viral (Coxsackievirus, adenovirus, parvovirus), bacterial (Chagas disease, Lyme disease).
    • Non-infectious: Autoimmune conditions (sarcoidosis, lupus), drug-induced myocarditis (e.g., chemotherapy).
  • Clinical Presentation:
    • Chest pain: Mimics acute coronary syndrome.
    • Heart failure symptoms: Dyspnea, orthopnea, fatigue, edema.
    • Palpitations or syncope from arrhythmias.
    • Systemic signs: Fever, myalgia in viral myocarditis.
  • Diagnosis:
    • ECG: ST/T wave abnormalities, ventricular arrhythmias, heart block.
    • Echocardiography: Reduced ejection fraction, ventricular dilation.
    • Cardiac MRI: Detects myocardial inflammation.
    • Blood tests: Elevated troponin, BNP.
  • Complications:
    • Heart failure, ventricular arrhythmias, dilated cardiomyopathy, and sudden death.
  • Treatment:
    • Supportive care: Oxygen, diuretics, ACE inhibitors, beta-blockers.
    • Antiarrhythmics for ventricular arrhythmias.
    • Immunosuppressants for autoimmune myocarditis.
    • --
Key Points
  • Pericarditis presents with sharp, pleuritic chest pain and a pericardial rub. Treatment involves NSAIDs, colchicine, and pericardiocentesis for tamponade.
  • Myocarditis mimics acute coronary syndrome and can cause heart failure or arrhythmias. ECG, cardiac MRI, and echocardiography are essential diagnostic tools.
  • Key complications: Pericarditis can lead to tamponade and constrictive pericarditis; myocarditis may cause heart failure, arrhythmias, and sudden death.