see also: [[STEMI mimics#Pericarditis|pericarditis ECG]], [[Myocarditis]] > [!Key Points] > - no troponin leak ; if trop leak and persistent tach, think *myopericarditis* - sharp chest pain - radiates to neck - dysphagia - better on sitting up - +/- low grade temp - diffuse [[STEMI mimics#Pericarditis|STE]] classic to have friction rub # ECG stages > - **Stage 1** – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks) > - **Stage 2** – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks) > - **Stage 3** – flattened T waves become inverted (3 to several weeks) > - **Stage 4** – ECG returns to normal (several weeks onwards) # pericarditis vs STEMI # Causes - *viral most common* - 80% - coxsackie B (sometimes A) - enteroviruses - adenovirus - parvo B19 - EBV - varicella - [[HIV]] - flu - mumps - lyme disease - Hep B - bacterial - usually S aureus , especially among [[Aboriginal health|indiginous australians]] - pneumococci - salmonella - post-MI (Dressler syndrome) -- autoimmune pericarditis post MI late complication 2 weeks after - *very common post cardiac surgery* ~ 20% of cases ! - radiation - *uraemia* - connective tissue / SLE - rheumatoid arthritis common - malignancy - especially lung, breast, lymphoma, leukemia, melanoma - myocarditis - [[Rheumatic fever]] - viral - granulomatous - *normal pregnancy* - asymptomatic pericardial effusion in healthy pregnancy 20% second trimester, 45% third trimester - also common post IVF stimulation or embryo transfer - [[Rash#serum sickness]] | category | examples | | ------------ | ---------------------------------------- | | infective | coxsakie B, S aureus (indiginous) | | iatrogenic | radiation-induced, post cardiac surgery | | inflammatory | [[Rheumatic fever]], myocarditis | | auto-immune | SLE, Dressler's syndrome (2 weeks later) | | other | uraemia, malignancy, idiopathic | # treatment - NSAIDS - ECHO (exclude effusion) - tx underlying cause