CARDIOLOGY

PERICARDITIS

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Take a systematic, focused history from someone with chest pain, and suggest key differential diagnoses
Understand the key causes of pericarditis and how to investigate them
Practice using guidelines to establish up-to-date treatment of pericarditis

Explain structure of session

Total time:

60 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Beth Brockbank

Uploaded:

17th September 2019

Last updated:

17th September 2019

Resources needed for this session:

Prescription chart, pen, paper

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

None

Activity 1: History Taking and Examination

20 min

Ask the student(s) to take a focused history from the patient, to include past medical history, drug history, social history and relevant family history. Following this, they should perform a full cardiovascular examination, paying close attention to heart sounds.

Activity 2: Case Presentation and Diagnostic Reasoning

10 min

Ask the student(s) to present the key findings of the case to you and suggest three key differentials and their reasoning. Give feedback on presentation style (max 1 minute).

Discuss the typical presenting complaints of pericarditis. Did you patient have these symptoms?
Discuss the differentials for the patient’s presentations. What makes them more or less likely?
Discuss the typical findings of pericarditis on examination.

Pericardial rub may be difficult to hear click here to listen to an example. The QR code opposite allows students to listen on their own phone.

Activity 3: ECG Interpretation

5 min

Review the patient's ECG with the student(s). Depending on the time and student level, either ask the student to present the ECG in a systematic manner or ask them to point out the main features suggesting pericarditis seen on an ECG. If no ECG is available use the example below.

What is the important differential of this ECG to consider?

Activity 4: Pathophysiology of Pericarditis

5 min

Discuss with students the possible causes of pericarditis. Try to classify them pathological processes e.g. using a surgical sieve such as "MEDIC HAT PIN" and highlight common vs. rare causes.

See below for an example table:

Activity 5: Investigations

10 min

Considering the above causes, discuss with the students:

What investigations will you request to confirm a diagnosis of pericarditis?
What other investigations might be useful to determine the underlying cause? If possible, use the hospital systems to practice requesting these scans in practice.
What complications may arise from pericarditis?
What complication is seen in this echocardiogram opposite?

Activity 6: Further Management Decisions

5 min

Ask the student(s) to find a relevant a guideline on management of pericarditis such as a local/hospital guideline, UpToDate or ESC guidelines. Discuss:

When prescribing anti-inflammatories what must we consider? (Think comorbidities, drug interactions, risks and side effects)
Does the patient you have seen need to be admitted to hospital?

The QR code opposite links to ESC pericardial disease guidelines.