Editing Pericarditis (section)

==Signs and symptoms==
Substernal or left [[Precordium|precordial]] [[pleuritic]] [[chest pain]] with radiation to the trapezius ridge (the bottom portion of [[scapula]] on the back) is the characteristic pain of pericarditis. The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and [[supine position]]s) or by inspiration (taking a breath in).<ref name=mk>{{cite book |author=American College of Physicians (ACP) |chapter=Pericardial disease |title=Medical Knowledge Self-Assessment Program (MKSAP-15): Cardiovascular Medicine |isbn=978-1-934465-28-8 |page=64 |chapter-url=http://www.acponline.org/products_services/mksap/15/complete.htm |url-status=live |archive-url=https://web.archive.org/web/20100802163510/http://www.acponline.org/products_services/mksap/15/complete.htm |archive-date=2010-08-02 |year=2009 |publisher=American College of Physicians }}</ref> The pain may resemble that of [[angina]] but differs in that pericarditis pain changes with body position, where heart attack pain is generally constant and pressure-like. Other symptoms of pericarditis may include dry [[cough]], [[fever]], fatigue, and [[anxiety]].{{citation needed|date=February 2021}}

Due to its similarity to the pain of [[myocardial infarction]] (heart attack), pericarditis can be misdiagnosed as a heart attack. Acute myocardial infarction can also cause pericarditis, but the presenting symptoms often differ enough to warrant diagnosis. The following table organizes the clinical presentation of pericarditis differential to myocardial infarction:<ref name=mk />

{| class="wikitable"
! scope="col" | Characteristic
! scope="col" | Pericarditis
! scope="col" | Myocardial infarction
|-
! scope="row" | 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."
|-
! scope="row" | 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 left arm, or does not radiate.
|-
! scope="row" | Exertion
| Does not change the pain
| Can increase the pain
|-
! scope="row" | Position
| Pain is worse in the [[supine position]] or upon inspiration (breathing in)
| Not positional
|-
! scope="row" | Onset/duration
| Sudden pain, that lasts for hours or sometimes days before a person comes to the ER
| Sudden or chronically worsening pain that can come and go in [[paroxysm]]s or it can last for hours before the person decides to come to the ER
|}

===Physical examinations===
The classic [[medical sign|sign]] of pericarditis is a [[pericardial rub|friction rub]] [[Auscultation|heard with a stethoscope]] on the cardiovascular examination, usually on the lower left [[Sternum|sternal border]].<ref name=mk /> Other physical signs include a person in distress, positional chest pain, diaphoresis (excessive sweating); possibility of heart failure in form of pericardial [[Cardiac tamponade|tamponade]] causing [[pulsus paradoxus]], and the [[Beck's triad (cardiology)|Beck's triad]] of [[hypotension|low blood pressure]] (due to decreased [[cardiac output]]), distant (muffled) heart sounds, and [[Jugular vein distension|distension of the jugular vein]] (JVD). The presence of a triphasic pericardial friction rub on auscultation. A bedside electrocardiogram (ECG) shows widespread concave ST elevation and PR depression throughout most of the limb and precordial leads.

===Complications===
Pericarditis can progress to [[pericardial effusion]] and eventually [[cardiac tamponade]]. This can be seen in people who are experiencing the classic signs of pericarditis but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, [[pulsus paradoxus]] (decrease of at least 10 mmHg of the systolic blood pressure upon [[Inhalation|inspiration]]), low blood pressure (due to decreased [[cardiac index]]), (jugular vein distention from right sided [[heart failure]] and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid.{{citation needed|date=February 2021}}

In such cases of cardiac tamponade, [[Electrocardiogram|EKG]] or [[Holter monitor]] will then depict [[electrical alternans]] indicating wobbling of the heart in the fluid filled pericardium, and the [[capillary refill]] might decrease, as well as severe vascular collapse and [[altered mental status]] due to hypoperfusion of body organs by a heart that can not pump out blood effectively.{{citation needed|date=February 2021}}

The diagnosis of tamponade can be confirmed with [[Transthoracic echocardiogram|trans-thoracic echocardiography]] (TTE), which should show a large pericardial effusion and diastolic collapse of the right ventricle and right atrium. [[Chest X-ray]] usually shows an enlarged cardiac silhouette ("water bottle" appearance) and clear lungs. Pulmonary congestion is typically not seen because equalization of diastolic pressures constrains the pulmonary capillary wedge pressure to the intra-pericardial pressure (and all other diastolic pressures).{{citation needed|date=February 2021}}