Features
• Pleuritic, sharp chest pain
o Worse when lying flat, better sitting forward
• May radiate to trapezius ridge (phrenic nerve involvement)
• Pericardial friction rub (high-pitched, superficial sound)
ECG changes
• Widespread concave ST elevation (all leads except aVR, V1)
• PR depression (specific for pericarditis)
Common causes
• Viral (coxsackie, echovirus)
• Post-MI (Dressler's syndrome: fever, pericarditis, pleural effusion ~2 weeks after MI)
• Uraemia
• Connective tissue diseases (e.g., SLE)
Treatment
• NSAIDs (e.g., ibuprofen)
• Colchicine (reduces recurrence)
• Steroids only if refractory or autoimmune cause
Features
• Dyspnoea, "globular" cardiac silhouette on CXR
• Diminished heart sounds
• Electrical alternans (beat-to-beat variation in QRS amplitude)
Causes
• Any cause of pericarditis
• Hypothyroidism ("myxoedema heart")
• Malignancy (lung, breast, lymphoma)
Features
• Beck’s triad:
o Hypotension (low cardiac output)
o Raised JVP (venous congestion)
o Muffled heart sounds
• Pulsus paradoxus
o Drop in systolic BP >10 mmHg on inspiration
• Tachycardia, dyspnoea, oliguria
Diagnosis
• Echo: diastolic collapse of RA/RV
• ECG: low voltage, electrical alternans
Management
• Urgent pericardiocentesis
Pathophysiology
• Thickened, calcified pericardium → diastolic dysfunction → equalisation of diastolic pressures
Features
• Similar to right heart failure (RHF): ascites, hepatomegaly, peripheral oedema
• Kussmaul’s sign: JVP rises on inspiration
• Pericardial knock (early diastolic sound)
Causes
• TB (common worldwide)
• Post-cardiac surgery, radiation, idiopathic
Imaging
• CT/MRI: pericardial thickening, calcification
Treatment
• Pericardiectomy (definitive)
Extra Revision Pearls
• Pericarditis clue → PR depression, concave ST elevation, pain improves sitting up
• Dressler’s clue → post-MI pericarditis, fever, pleuritis
• Tamponade clue → hypotension + high JVP + muffled heart sounds + pulsus paradoxus
• Electrical alternans clue → large effusion or tamponade
• Constrictive clue → RHF + Kussmaul’s + pericardial knock
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
