Acute Pericarditis: Recognizing the Key Clinical Signs

Acute pericarditis presents with distinct physical findings that help clinicians identify the condition early and initiate appropriate management. Understanding these signs is crucial for timely diagnosis and treatment.

Signs of Effusive Pericarditis

One of the hallmark signs of effusive pericarditis is diminished or absent apical impulse. This occurs due to the accumulation of fluid around the heart, which restricts normal cardiac movement. Additionally, physical examination may reveal an increased cardiac dullness extending bilaterally, suggesting pericardial effusion.

Patients often exhibit tachycardia, with an elevated heart rate being a compensatory mechanism in response to reduced cardiac output. Heart sounds may become muffled or distant, a key clue in identifying pericardial involvement.

Hemodynamic Changes and Their Effects

In cases of significant pericardial effusion, systolic blood pressure may decrease while diastolic pressure remains relatively stable, resulting in a narrowed pulse pressure. This hemodynamic change can impair venous return, leading to jugular venous distension, hepatomegaly, peripheral edema, and even ascites.

Fibrous Pericarditis: Characteristic Findings

Fibrous pericarditis is typically associated with a characteristic auscultatory finding known as the pericardial friction rub. This high-pitched, scratchy sound is best heard along the left sternal border at the third and fourth intercostal spaces.

The friction rub results from the rubbing of inflamed visceral and parietal pericardial layers during cardiac motion. Some patients may also experience a palpable pericardial friction rub, which can be detected during physical examination.

Acute Cardiac Tamponade: A Medical Emergency

Rapid fluid accumulation can lead to acute cardiac tamponade, a life-threatening condition characterized by circulatory collapse and shock. In contrast, when fluid accumulates more gradually, subacute or chronic tamponade may develop.

This slower progression typically manifests with systemic venous congestion and a unique clinical finding called pulsus paradoxus—an abnormal decrease in systolic blood pressure during inspiration. Recognizing these subtle signs is essential for early intervention and improved patient outcomes.