References

Black J, Thompson F. Clinical directive 85: high risk non traumatic chest pain.Winchester: South Central Ambulance Service NHS Trust; 2012

British Heart Foundation. Pericarditis. 2019. https//tinyurl.com/suxyhb7 (accessed 5 March 2020)

JRCALC clinical guidelines 2019. Bridgwater: Class Professional Publishing Camm A. Cardiovascular disease, 4th edn. In: Kumar P, Clark M (eds). Edinburgh: WB Saunders; 1999

Dato I, Coluzzi G, Al-Mohanni G A young man with intractable ascites and effort dyspnoea without echocardiographic signs of pericardial thickening: the importance of clinical investigation, CT scan and MRI in the diagnosis of constrictive pericarditis. Int J Cardiol. 2008; 128:(2)e79-e81 https://doi.org/10.1016/j.ijcard.2007.05.070

Derrickson BH, Tortora GJ. Principles of Anatomy and Physiology, 12th edn. : Wiley and Sons; 2009

Dudzinski DM, Mak GS, Hung JW. Pericardial diseases. Curr Probl Cardiol. 2012; 37:(3)75-118 https://doi.org/10.1016/j.cpcardiol.2011.10.002

Gianni F, Solbiati M Colchicine is safe and effective for secondary prevention of recurrent pericarditis. Intern Emerg Med. 2012; 7:(2)181-182 https://doi.org/10.1007/s11739-012-0775-z

Herlitz J, Bång A, Omerovic E, Wireklint-Sundström B. Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? The relief of both pain and anxiety is needed. Int J Cardiol. 2011; 149:(2)147-151 https://doi.org/10.1016/j.ijcard.2010.10.012

Imazio M, Demichelis B, Parrini I Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. 2004; 43:(6)1042-1046 https://doi.org/10.1016/j.jacc.2003.09.055

Knudson JD. Diseases of the pericardium. Congenit Heart Dis. 2011; 6:(5)504-513 https://doi.org/10.1111/j.1747-0803.2011.00556.x

Lin Y, Zhou M, Xiao J, Wang B, Wang Z. Treating constrictive pericarditis in a chinese single-center study: a five-year experience. Ann Thorac Surg. 2012; 94:(4)1235-1240 https://doi.org/10.1016/j.athoracsur.2012.05.002

Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR. Oxford Handbook of Clinical Medicine, 8th edn. Oxford: Oxford University Press; 2010

Mayo Clinic. Dressler's syndrome. 2020. http//www.mayoclinic.com/health/dresslers-syndrome/DS00666 (accessed 4 March 2020)

National Institute of Health and Care Excellence. 2020. https//bnf.nice.org.uk/ (accessed 4 March 2020)

Neupert W, Brugger R, Euchenhofer C, Brune K, Geisslinger G. Effects of ibuprofen enantiomers and its coenzyme A thioesters on human prostaglandin endoperoxide synthases. Br J Pharmacol. 1997; 122:(3)487-492 https://doi.org/10.1038/sj.bjp.0701415

Pericardial disease. 2015. https//tinyurl.com/6wzltu (accessed 4 March 2020)

Rahman A, Liu D. Pericarditis—clinical features and management. Aust Fam Physician. 2011; 40:(10)791-796

Salami MA, Adeoye PO, Adegboye VO, Adebo OA. Presentation pattern and management of effusive-constrictive pericarditis in Ibadan. Cardiovasc J Afr. 2012; 23:(4)206-211 https://doi.org/10.5830/CVJA-2011-066

Shabetai R. Pericardial effusion: haemodynamic spectrum. Heart. 2004; 90:(3)255-256 https://doi.org/10.1136/hrt.2003.024810

Cardiac tamponade. https//www.ncbi.nlm.nih.gov/books/NBK431090/ (accessed 5 March 2020)

Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004; 363:(9410)717-727 https://doi.org/10.1016/S0140-6736(04)15648-1

Pericarditis. 2019. http//www.medicinenet.com/pericarditis/page4.htm (accessed 4 March 2020)

Wyatt JP, Illingworth RN, Clancy M, Greaves I. The Oxford handbook of emergency medicine.Oxford: Oxford University Press; 2008

Constrictive pericarditis. 2019. https//www.ncbi.nlm.nih.gov/books/NBK459314/ (accessed 5 March 2020)

Young PM, Glockner JF, Williamson EE MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging. 2012; 28:(5)1099-1109 https://doi.org/10.1007/s10554-011-9916-0

clinical practice

Non-traumatic chest pain: pericarditis

02 March 2020
Features
02 March 2020
Volume 12 · Issue 3

Abstract

Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction. Its signs and symptoms include chest pain, which may radiate to the arm and jaw and pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over each other) on auscultation of heart sounds. The diagnosis of straightforward pericarditis may be within the scope of practice of the emergency care practitioner. It should be possible for an emergency care practitioner to reach a working diagnosis and to initiate a treatment regimen, which would predominantly consist of providing analgesia to make the patient more comfortable.

After completing this module, the paramedic will be able to:

This article will look at the pathophysiology, signs and symptoms/presentation and management of pericarditis. It will also examine the evidence and discuss the issues surrounding the need for hospital admission versus management within the community or primary care setting.

‘Pericarditis is inflammation of the pericardium, the protective sac that surrounds your heart. The pericardium has two layers (inner and outer) and can become inflamed if blood or fluid leaks between these two layers.’

The pericardium surrounds the cardiac muscle. It consists of two layers of tissue, encapsulating part of the aorta and vena cava (Knudson, 2011: 504). As well as protecting and restraining the heart, it determines cardiac filling by preventing the myocardium from becoming overstretched (Troughton et al, 2004: 718).

Pericarditis falls into two categories:

Evidence from the United States suggests that pericarditis is relatively rare, accounting for <1% of hospital admissions. It is most common in men aged 20–50 years, although it also occurs in women (Phelan et al, 2015).

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