Paediatrics: Pericarditis

Pericarditis

Inflammation of the pericardium may be p or a manifestation of more generalized illness. The principal causes of pericardial inflammation are:

·  Infections:

·  viral, e.g. coxsackie B, Epstein–Barr virus (EBV);

·  bacterial, e.g. streptocococcus, mycoplasma;

·  tuberculosis;

·  fungal, e.g. histoplasmosis;

·  parasitic, e.g. toxoplasmosis.

·  Connective tissue:

·  rheumatoid arthritis;

·  rheumatic fever;

·  systemic lupus erythematosus (SLE);

·  sarcoidoisis.

·  Metabolic:

·  hyperuricaemia;

·  hypothyroidism.

·  Malignancy.

·  Radiotherapy.

Clinical features

The features depend on the extent of involvement of the pericardium. The predominant symptom is precordial pain that is typically sharp, exac-erbated and exaggerated by lying down, and relieved by sitting or leaning forward. The pain is often referred to the left shoulder. Other symptoms include cough, dyspnoea, and fever.

The accumulation of sufficient fluid to cause cardiac tamponade and heart failure is rare.

Examination

Specific diagnostic findings will relate to the amount of fluid within the pericardial sac, including pulsus paradoxus, pericardial rub, quiet/distant heart sounds.

Investigations

Investigations directed at confirming the diagnosis include:

·  echocardiogram;

·  ECG (typical low voltage QRS complexes).

Other investigations should be directed at identifying the underlying cause of the pericarditis and will include: pericardiocentesis, bacterial/viral cul-ture and biochemical analysis; blood serology for viral studies, ASOT, and connective tissue disease.

Management

Treatment is directed both at the underlying cause, e.g. antibiotics, and symptoms, e.g. the following:

·Analgesia for pain relief.

·Anti-inflammatory drugs to reduce pericardial inflammation.

·Pericardiocentesis for pericardial effusion causing cardiac tamponade and heart failure.

Constrictive pericarditis

Previous pericardial inflammation may predispose to this condition. However, most cases of constrictive pericarditis occur in the absence of any preceding illness or generalized systemic disease. The fibrosed restric-tive pericardium impairs cardiac contractility.

Clinical features

Include evidence of heart failure, hepatomegaly, and neck vein distention. On auscultation, heart sounds are distant and a characteristic pericardial ‘knock’ is often heard. CXR may reveal calcification of the pericardium.

Treatment 

Requires pericardiectomy.