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Pericarditis for USMLE Step 2 & COMLEX-USA Level 2

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Overview of Pericarditis
    • Definition: Inflammation of the pericardium, the fibrous sac surrounding the heart.
Etiology
  • Causes:
    • Infectious: Viral (e.g., coxsackievirus, echovirus) is most common.
    • Non-infectious: Autoimmune diseases (e.g., lupus, rheumatoid arthritis), post-myocardial infarction (Dressler's syndrome), uremia, and radiation therapy.
    • Idiopathic: Often presumed viral in origin.
Clinical Presentation
    • Chest Pain: Sharp and pleuritic, typically worsens with inspiration and improves with sitting up and leaning forward.
    • Pericardial Friction Rub: Scratchy, high-pitched sound best heard at the left sternal border during end expiration with the patient leaning forward.
    • Other Symptoms: Dyspnea, fever, and general malaise.
Diagnosis
  • ECG Findings:
    • Diffuse ST elevation and PR depression are typical in the acute phase.
  • Echocardiography:
    • Useful for detecting pericardial effusion and evaluating for cardiac tamponade.
  • Laboratory Tests:
    • Elevated inflammatory markers (CRP, ESR), but specific etiology often requires further investigation based on clinical context.
Management
  • Medical Treatment:
    • NSAIDs: First-line treatment for pain and inflammation.
    • Colchicine: Reduces inflammation and prevents recurrence.
    • Corticosteroids: Reserved for severe cases or those refractory to first-line treatments, or specific causes like autoimmune disorders.
  • Monitoring and Follow-Up:
    • Monitor for signs of cardiac tamponade and constrictive pericarditis, especially in severe cases.
Essential Points for USMLE Step 2
    • Pain Management: NSAIDs combined with colchicine is effective for reducing symptoms and preventing recurrence.
    • Identify Serious Complications: Be vigilant for cardiac tamponade, which presents with hypotension, jugular venous distension, and muffled heart sounds (Beck's triad).
    • Differentiation from MI: Unlike myocardial infarction, pericarditis causes diffuse ST elevation without reciprocal ST depression, and troponin may be mildly elevated or normal unless myopericarditis is present.