A serial ECG may show evidence of pericarditis. There will often be classic upward concave elevations of the ST segment, which are seen in Figure 8:
Figure 8.
In looking for a cause of the pericarditis, it is not necessary to do much in a healthy young person who likely has idiopathic or viral disease. Other testing done if necessary include a diagnostic pericardiocentesis or a pericardial biopsy, looking for things like tuberculosis, cancer, or bacterial infection. Besides a culture and cytology of the fluid, other tests of the fluid are nonspecific and not helpful in making the diagnosis. There are blood tests for autoimmune disease, acute-phase reactants, HIV disease, viral antibodies, and a CBC that can be done. When treating these patients, those with severe features need hospitalization. Stop all possible causative drugs and do a pericardiocentesis if this is causing symptoms. A pericardiocentesis without an echocardiogram to guide the procedure can be lethal so it should wait until it can be done under guidance. Colchicine or aspirin can be used for pain and prednisone for a week will help if the colchicine or aspirin do not help. In refractory disease, triamcinolone can be injected into the pericardial space. Severe constrictive pericarditis is treated surgically with resection of the pericardial sac but the mortality rate of the procedure itself is high.
ENDOCARDITIS Endocarditis can be due to several things but most are infectious and most infections are due to staph or strep infections. Fungal infections can also cause this problem. Expect to see fever, petechiae, heart murmurs, embolic diseases, anemia, and an imaging study showing endocardial vegetations on the heart valves. In noninfective 26
