284.2 🩺 國考版

284.2.1 高頻考點

284.2.1.1 Acute Pericarditis Dx (2 of 4)

  1. Pericarditic chest pain (sharp, pleuritic, positional)
  2. Friction rub
  3. Diffuse ST↑ + PR↓
  4. New/worsening pericardial effusion

284.2.1.2 Common Causes

  • Viral / idiopathic (80%)
  • Post-MI (early, Dressler)
  • Post-cardiac surgery
  • Uremic
  • Autoimmune (SLE, RA)
  • TB (constrictive risk!)
  • Malignancy
  • Drugs (hydralazine, procainamide, INH)

284.2.1.3 ECG of Pericarditis

  • Diffuse ST↑ (not territorial)
  • PR↓ (most specific)
  • PR↑ in aVR
  • 4 stages: STE → normalize → T inversion → normal

284.2.1.4 Treatment

  • NSAID + colchicine 3 months (CORP, ICAP, COPE)
  • Avoid steroids first-line (↑ recurrence)
  • Rilonacept (IL-1 trap) for refractory recurrent (RHAPSODY 2020)
  • Pericardiectomy for incessant

284.2.1.5 Tamponade

  • Beck triad: hypotension + JVD + muffled HS
  • Pulsus paradoxus > 10 mmHg
  • ECG: low voltage, electrical alternans
  • Echo: RA/RV collapse, IVC plethora
  • Emergency pericardiocentesis

284.2.1.6 Constrictive Pericarditis

  • TB most common globally; surgery + radiation most common in developed
  • Echo: septal bounce, respiratory variation, preserved e’
  • CMR: thickening > 4 mm
  • Cath: square root sign, equalization
  • Treatment: pericardiectomy

284.2.2 易混淆比范

Feature Pericarditis Constrictive Tamponade
Pain Pleuritic, positional Less common Variable
Rub Yes No Sometimes
ECG Diffuse ST↑ + PR↓ LV/AF Low voltage, alternans
JVP Normal/↑ Markedly ↑, Kussmaul Markedly ↑
Pulsus paradoxus No Sometimes Yes (> 10 mmHg)
Treatment NSAID + colchicine Pericardiectomy Pericardiocentesis

284.2.3 Key Trials

  • CORP (2005), ICAP (2013), COPE (2005): colchicine ↓ recurrence
  • RHAPSODY (2020): rilonacept for recurrent pericarditis (FDA 2021)
  • AIRTRIP (2016): anakinra for refractory