Pericarditis differential diagnosis
|
Pericarditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Surgery |
|
Case Studies |
|
Pericarditis differential diagnosis On the Web |
|
American Roentgen Ray Society Images of Pericarditis differential diagnosis |
|
Risk calculators and risk factors for Pericarditis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
For a full discussion of the differential diagnosis of chest pain click here
For an expert algorithm that aids in the diagnosis of the cause of chest pain click here
Differentiating Pericarditis from other Conditions
Several conditions, including life threatening conditions such as myocardial infarction, aortic dissection and pulmonary embolism produce signs and symptoms that are similar to those produced by pericarditis. Although the following features are not 100% sensitive and/or specific in distinguishing the different causes of chest pain, they are useful guides:
- Pain along the trapezius ridge(s), is very characteristic of pericarditis. The pain of myocardial infarction tends to involve the anterior precordium with radiation to the left arm.
- Unlike cardiac ischemia, the pain of pericarditis often lasts longer, and is unresponsive to vasodilator therapy.
- Ischemic chest pain is often described as a sense of "heaviness" whereas the pain of pericarditis is often pleuritic in nature.
- Ischemic chest pain is generally not positional in nature whereas the pain of pericarditis may be relieved by sitting forward.
- The EKG of pericarditis shows PR segment depression while the EKG of myocardial infarction does not (unless there is atrial infarction).
- The EKG of pericarditis shows ST elevation that does not necessarily follow the anatomic distribution of a single coronary artery.
Clinical presentation
Substernal or left precordial pleuritic Chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back), which is relieved by sitting up and bending forward and worsened by lying down (recumbent or supine position) or inspiration (taking a breath in), is the characteristic pain of pericarditis.[1] The pain, may resemble the pain of angina pectoris or heart attack but differs in that pain changes by body positions, as opposed to heart attack pain that is pressure-like, and constant with radiation to the left arm and/or the jaw. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Due to similarity to myocardial infarction (heart attack) pain, pericarditis can be misdiagnosed as an acute myocardial infarction (a heart attack) solely based on the clinical data and so extreme suspicion on the part of the diagnostician is required. Ironically an acute myocardial infarction (heart attack) can also cause pericarditis, but often the presenting symptoms vary enough to warrant a diagnosis. The following table organises the clinical presentation of pericarditis:[1]
| Characteristic/Parameter | Pericarditis | Myocardial infarction |
|---|---|---|
| Pain description | Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain | Crushing, pressure-like, heavy pain. Described as "elephant on the chest." |
| Radiation | Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation. | Pain radiates to the jaw, or the left or arm, or does not radiate. |
| Exertion | Does not change the pain | Can increase the pain |
| Position | Pain is worse supine or upon inspiration (breathing in) | Not positional |
| Onset/duration | Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER | Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER |