FH NR 6/11: Pericarditis and Uremia

=====On June 11, Dr. Matt Hemsing gave a NR on Uremic Pericarditis====

Pericarditis

- Def’n: Inflammation of pericardial sac

- Terminology: Myopericarditis (prevalent pericarditis, normal EF) vs Perimyocarditis (prevalent myocarditis, reduced LV function)

- 2+ criteria needed for Dx:

1. Typical chest pain (sharp and pleuritic, improved by sitting up and leaning forward)

2. Pericardial friction rub

3. Suggestive changes on the ECG (widespread ST segment elevation, PR depressions) 4. New or worsening pericardial effusion

* Pearl: Absence of pericardial effusion does not rule out pericarditis

- Etiology: mostly idiopathic (presumed viral).

- Hospitalization Criteria: True fever, sub-acute course (without acute onset of chest pain), cardiac tamponade / Lg effusion, Immunocompromised, Anticoag use, Acute trauma, Failure to show clinical improvement following seven days of appropriately dosed NSAID and colchicine therapy, Elevated cardiac troponin (myocarditis component).

- Treatment: NSAIDS or ASA for inflammation, and colchicine to prevent recurrence. - ASA preferred in: CAD, HF, Kidney disease pts

- No superiority in either NSAIDS or ASA has been shown in literature

- Glucocorticoids only in refractory or very special cases.

- Activity restriction following Dx

- Pericarditis by itself: after trop normalizes (if non-comp athlete), 3+ mos after dx and normalization of biomarkers (if competitive athlete)

- Myocardial involvement (myopericarditis): 6 months no competitive sports, return after trop normalizes

- Uremic Pericarditis: Usually requires BUN >60 - Apart from medical mngmt, dialysis is part of Rx (be careful if removing fluid (ultrafiltration) as transient decrease in pre-load could induce tamponade

- Indications to Dialyze in Uremia

1. Uremia causing pericarditis

2. Uremia causing uremic encephalopathy

3. Uremia causing bleeding that is REFRACTORY to medical therapy