9 A Toolkit for Health Care Professionals Recurrent Pericarditis Structured History Taking for Acute Pericarditis The goal of history taking is to: Gather data to make a diagnosis Exclude important differentials Identify features of any relevant systemic disease for which pericarditis may be a manifestation Detect comorbidities that may impact therapy Anticipate any social or occupational factors that may impinge on ongoing care. The following is not a comprehensive list, but is intended to highlight questions that are particularly relevant to identifying these features or manifestations of disorders that may accompany pericarditis or complicate its treatment. Chest pain history A comprehensive chest pain history includes onset, timing, quality, severity, radiation, associated symptoms and exacerbating and relieving factors. Typical chest pain in acute pericarditis is sharp, sudden onset and pleuritic — worse with inspiration or cough, worse laying backward and improved when sitting forward. Referred pain is also common, especially to the shoulder region. In cases of recurrent pericarditis, patients often can sense the pain coming prior to a full-blown episode. A history should also be taken to assess for complications of pericarditis, including clinical tamponade such as syncope, lightheaded/dizziness, nausea and myopericarditis such as those indicative of LV dysfunction — shortness of breath, abdominal swelling and lower extremity edema. Personal medical and surgical history Any previous episodes of acute pericarditis? { What were the circumstances in which these occurred? { Were there any complicating features (e.g., incessant course, large effusion, tamponade)? { What was the treatment given (duration, intensity)? { Did the patient adhere to the treatment? If not, why not? Was this due to side effects, medication costs, lack of knowledge? Any previous history of trauma to the chest or interventional cardiac or cardiothoracic surgical procedures? Any past history of asthma and in particular, asthma exacerbation with NSAIDs? Any past history of peptic ulcer disease/GI blood loss, significant gastroesophageal reflux disease, H pylori infection, bleeding diathesis or renal or hepatic impairment? Any history of diabetes mellitus, obesity, osteopenia/ osteoporosis/fragility fractures, vitamin D deficiency, coronary disease (which may favor use of aspirin over NSAIDs), hypertension, renal impairment or hepatic dysfunction? Any history of autoimmune rheumatic disease, inflammatory bowel disease, autoinflammatory disease or immunodeficiency (severe, prolonged, recurrent or unusual infections)? Any comorbidities that may necessitate co-prescription of potent cytochrome P450, family 3, subfamily A (CYP3A4) and/or P-glycoprotein inhibitors? Any past history of TB or exposure to this bacterial infection? Any history of abdominal surgery, particularly negative laparotomies? Any history of cancer/radiotherapy? Any psychiatric history (which may be relevant to steroid prescribing and holistic care)? Any history of claustrophobia or implants?
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