Internal Diseases · MU Sofia

Theory · 18. Pericarditis

Covers pericarditis, from its definition and classification by duration and exudate type through its many causes, including infectious, autoimmune, post-infarction and uraemic forms. It then describes the pathophysiology and the symptoms and signs of dry, exudative and constrictive disease, including tamponade and paradoxical pulse. The note closes with laboratory tests, ECG, chest X-ray, echocardiography, abdominal ultrasound and pericardiocentesis.

Inside: 9 sections · 7 labelled pictures · 14 flashcards · 4 min

Topic 17 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 9 sections, about 480 words (4 min of reading), with 14 flashcards.

In this note

  1. Pericarditis
  2. Definition
  3. Classification
  4. Etiology
  5. Pathophysiology
  6. Symptoms
  7. Physical Examination
  8. Lab Tests
  9. Instrumental Tests

Definition

Inflammation of the pericardium, the fibrous sac that surrounds the heart. It can affect both the serous and fibrous layers, leading to functional complications such as pericardial effusion, tamponade, or constriction.

Classification

  • According to duration:
  • Acute: < 6 weeks
  • Subacute: 6 weeks to 6 months
  • Chronic: > 6 months
  • According to exudate type:
  • Serous
  • Purulent
  • Fibrinous
  • Caseous
  • Haemorrhagic

Etiology

  • Infectious causes:
  • Viral: Coxsackie, HIV, Herpes
  • Bacterial: Mycobacterium tuberculosis (especially in endemic areas)
  • Fungal
  • Idiopathic
  • Autoimmune diseases: e.g. Systemic lupus erythematosus, Rheumatic fever
  • Dressler’s syndrome: autoimmune pericarditis post-MI
  • Paraneoplastic: associated with malignancies
  • Uremic pericarditis: in end-stage chronic renal failure due to uremic toxins
  • Postpericardiotomy syndrome: after cardiac surgery
  • Trauma: blunt or penetrating trauma to the heart
  • Radiation-induced
  • Hypothyroidism: associated with serous pericardial effusion

Pathophysiology

  • Initiation by inflammatory trigger → local vasodilation (VD) and ↑ capillary permeability
  • Plasma proteins, especially fibrinogen, leak into pericardial space → fibrin deposition
  • Accumulation of WBCs (mainly neutrophils, lymphocytes depending on cause)
  • Over time, fibrosis may develop → thickened and stiff pericardium
  • This impairs diastolic filling, leading to ↓ stroke volume, ↑ HR, and potentially HF

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