Pericarditis

Populations and Risk Factors

Young adults (ages 20-50), more common in men
Post-viral infection (most common cause — Coxsackie B, influenza, HIV)
Post-myocardial infarction (Dressler syndrome, occurring weeks to months after MI)
Autoimmune conditions: lupus, rheumatoid arthritis, scleroderma
End-stage renal disease (uremic pericarditis)
Post-cardiac surgery or chest trauma
Cancer metastasis to the pericardium
Recurrence in 15-30% of cases

Viral infection is the most common cause in developed countries — direct pericardial invasion triggers inflammatory response with fibrin deposition and fluid exudation
Pericardial effusion: Accumulation of serous, hemorrhagic, or purulent fluid between the visceral and parietal pericardium
Cardiac tamponade: Rapid fluid accumulation compresses the heart, impairs diastolic filling, and causes cardiogenic shock — medical emergency
Constrictive pericarditis: Chronic inflammation leads to fibrosis and calcification restricting cardiac filling (a late complication)
Autoimmune causes: Immune complex deposition and complement activation in the pericardium

Sharp, pleuritic chest pain that worsens with inspiration, coughing, and lying supine. Improves sitting up and leaning forward (classic positional relief)
Pericardial friction rub on auscultation — scratchy, squeaking sound. Pathognomonic for pericarditis
Low-grade fever, malaise, dyspnea
Tamponade signs (Beck triad): Hypotension, distended neck veins, muffled heart sounds — call 911 immediately
Recurrent episodes in 15-30% of cases
Red flags: Beck triad = cardiac tamponade = emergency; chest pain with hemodynamic instability requires immediate emergency referral

Category A7 Systemic Conditions — Cardiovascular
Must differentiate pericarditis chest pain (positional, pleuritic, improves leaning forward) from MI (crushing, radiating, not positional)
Active pericarditis requires medical clearance before massage
Beck triad indicates tamponade — emergency recognition is essential
Dressler syndrome (post-MI pericarditis) may present weeks after a cardiac event

Active pericarditis: Contraindicated for massage. Any signs of tamponade require immediate emergency referral
Resolved/stable with clearance: Gentle, relaxation-focused massage is appropriate. Stress reduction may help prevent recurrence in autoimmune cases
Positioning: Semi-reclined may be preferred over prone (which may cause chest discomfort). Avoid positions that increase chest pressure
Vigorous techniques that increase heart rate or blood pressure are contraindicated even in resolved cases
Monitor for chest pain recurrence during treatment — stop and refer if symptoms return
Medication awareness: Colchicine (reduces recurrence by 50%) can cause GI symptoms. NSAIDs increase bruising risk slightly

Pericarditis presents with sharp, positional chest pain that improves with sitting forward — distinct from MI
Most cases are viral and self-limiting, but effusion and tamponade are life-threatening complications
Active pericarditis is a contraindication to massage. Treat only after resolution with physician clearance
Beck triad (hypotension, distended neck veins, muffled heart sounds) indicates tamponade — call 911
Recurrence is common (15-30%). Colchicine is the modern standard for preventing recurrence