Pericarditis II: Clinical Features and Diagnostic Tests

Pericarditis typically presents with sharp, pleuritic chest pain that radiates beneath the clavicle, into the neck, or toward the left trapezius region. This pain worsens with deep inspiration, lying flat, or turning. The pain remains relatively constant but is distinctly affected by body position and breathing patterns, distinguishing it from other cardiac conditions.

A pericardial friction rub is a scratchy, creaky sound caused by inflamed pericardial layers rubbing against each other. It is best heard at the left lower sternal border, particularly when the patient leans forward and holds their breath after expiration. This hallmark clinical manifestation is detected during auscultation and confirms pericardial inflammation.

Acute pericarditis shows diffuse ST segment elevations across multiple leads on the electrocardiogram. PR-segment depression is also a characteristic finding. These distinctive ECG changes help differentiate pericarditis from myocardial infarction and support early diagnosis of pericardial inflammation and myocardial involvement.

Laboratory tests in pericarditis typically show leukocytosis, elevated C-reactive protein, and increased erythrocyte sedimentation rate, all indicating inflammation. Elevated troponin levels may indicate concurrent myocardial damage, which can occur in myopericarditis. These findings support the diagnosis and help assess disease severity.

Echocardiography is crucial for detecting pericardial effusion, inflammation, and tamponade while assessing heart function. It can identify fluid accumulation in the pericardial sac and evaluate the severity of pericardial involvement. This imaging technique helps determine whether complications like cardiac tamponade are present.

Pericarditis patients commonly experience mild fever, nonproductive cough, dyspnea, tachycardia, fatigue, and anemia. These systemic symptoms reflect the inflammatory nature of the disease. In severe cases, signs of heart failure may develop due to pericardial compression from constrictive pericarditis or cardiac tamponade.

Pericardiocentesis and pericardial biopsy are invasive procedures used to determine the underlying cause of pericarditis, such as infection or malignancy. Pericardiocentesis involves aspiration of pericardial fluid for analysis, while biopsy obtains tissue samples, especially when tuberculosis or malignancy is suspected. These procedures guide targeted treatment.