What are the most common causes of acute pericarditis?

In the outpatient setting, pericarditis is usually idiopathic. It is thought that viral infection probably comprises many of the cases categorized as idiopathic. The coxsackie A and B viruses are highly cardiotropic and are two of the most common viruses to lead to pericarditis and myocarditis. Other viruses associated with pericarditis include mumps, varicella-zoster, influenza, Epstein-Barr, and human immunodeficiency virus (HIV).

In the inpatient setting, some of the more common etiologies can be recalled with the mnemonic TUMOR. Tumor also serves as a useful reminder that metastatic cancer is a frequent cause of pericarditis and pericardial effusion in hospitalized patients.

T = Trauma U = Uremia

M = Myocardial infarction (acute and post), Medications (e.g., hydralazine and procainamide)

O = Other infections (bacterial, fungal, tuberculous)

R = Rheumatoid arthritis and other autoimmune disorders, Radiation.

How does the pain of pericarditis differ from the pain of myocardial infarction?

It is important to understand how pericarditis pain differs from that of myocardial infarction because the two processes may share some of the same features and can be confused. Both pericarditis and myocardial infarction may produce retrosternal or precordial chest pain with radiation to the neck, back, left shoulder, or left arm. However, pericarditis pain differs in that it is far more likely to be sharp and pleurtic, becoming worse with coughing or inspiration. Usually, thoracic motion does not change the intensity of ischemic pain. In contrast, pericarditis pain is often worsened by lying supine and relieved by sitting forward. Another important historical point is that some patients report exacerbation of pericarditis pain with swallowing.

Which auscultatory finding is pathognomonic for pericarditis?

The pericardial friction rub is pathognomonic for pericarditis. Rubs often have a characteristic scratching or grating sound that is heard best with the diaphragm of the stethoscope. Classically, rubs are described as having three components:

A presystolic rub during atrial filling

A ventricular systolic rub (the loudest component and the one almost always present)

A ventricular diastolic rub following the second heart sound.

A rub in the same patient may vary from faint to loud and may sometimes transiently disappear.

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