Common cause of Acute Dry Pericarditis: viral infection

CLINICAL FEATURES:

Onset is acute.

SYMPTOMS:

1. Pain: Three types of pain may be present.
2. a) Pleuritic pain related to respiration, coughing, sneezing, etc.
3. b) Steady, crushing substernal pain like myocardial infarction.
4. c) Pain in left shoulder, left arm, neck and left border of heart.

The visceral and the internal surfaces of parietal pericardium are insensitive to pain ordinarily. The pain in pericarditis is usually due to associated pleuritis and inflammation of part of pericardium supplied by phrenic nerve. This pain is often reduced when the patient sits up or leans forwards. In cases of uraemia, malignant involvement of pericardium, myocardial infarction and myxodema, pain may be absent.ACUTE DRY PERICARDITIS

2. Fever of low grade type is usually present. It is absent in cases of uraemia, malignant infiltration, myxodema and in trauma.

SINGS:

Temperature may be raised in infectious cases. Pulse shows tachycardia. Sometimes pericardial rub may be palpable. On auscultation over the heart pericardial friction sound may be audible which is the diagnostic sign of this condition. Characteristic features of this friction sound are:ACUTE DRY PERICARDITIS

1. a) To and fro in character.
2. b) Leathery creaking, scratching
3. c) Limited over the precordium, best heard on the left 4^th space close to the sternum (area of superficial cardiac dullness).
4. d) Biphasic-both systolic and early diastolic. Atrial contraction may give a third (presystolic) component to the rub.
5. e) It is heard even if the breath is suspended.
6. f) On pressing the chest piece of stethoscope the sound is augmented.
7. g) Patient may complain of pain.
8. h) Rub can be heard by both bell and diaphragm of stethoscope.
9. i) The rub changes from day to day.

INVESTIGATIONS:ACUTE DRY PERICARDITIS

1. Blood may show leucocytosis. ESR is raised.
2. ECG in early stages shows elevation of S-T segments with concavity upwards in all the leads except in aVR (S-T stage). This change lasts for 2 weeks. Gradually T wave changes are seen in the from of flattening or inversion (T stage) which may persist for 3 weeks or longer. These changes are due to epicardial injury.
3. Echocardiogram may show thickening of pericardium and fluid collection
4. SGOT and LDH levels may be elevated
5. Skiagram of chest may show enlarged cardiac shadow even in absence of pericardial effusion.