Pericarditis

Pericarditis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Inflammation of the pericardium, with or without associated pericardial effusion. Myopericarditis or perimyocarditis refers to cases that have myocardial involvement in addition to involvement of the pericardium.

Epidemiology

Incidence
Epidemiologic studies are lacking. Exact incidence is unknown but occurs in up to 5% of patients evaluated in the ER for chest pain without myocardial infarction (MI); appears to be a slightly increased prevalence in men

Etiology and Pathophysiology

  • Inflammation of the pericardial sac can be acute or chronic (recurrent). Chronic/recurrent inflammation may result in constrictive pericarditis.
  • Can produce serous/purulent fluid/dense fibrinous material (depending on etiology), which may or may not lead to hemodynamic compromise
  • Idiopathic: 85–90% of cases; likely related to viral infection, which may trigger immune-related process
  • Infectious
    • Viral: coxsackievirus, echovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, hepatitis viruses, influenza virus, HIV, measles, mumps, varicella
    • Bacterial: gram-positive and gram-negative organisms
    • Fungal (more common in immunocompromised populations): Blastomyces dermatitidis, Candida sp., Histoplasma capsulatum
    • Mycobacterial: Mycobacterium tuberculosis
    • Parasites: Echinococcus
  • Noninfectious causes
    • Acute MI (2 to 4 days after MI), Dressler syndrome (weeks to months after MI)
    • Aortic dissection
    • Renal failure, uremia, dialysis-associated
    • Malignancy (e.g., breast cancer, lung cancer, Hodgkin disease, leukemia, lymphoma)
    • Radiation therapy
    • Trauma
    • Postpericardiotomy
    • After cardiac procedures (e.g., catheterization, pacemaker placement, ablation)
    • Autoimmune disorders: connective tissue disorders, systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, hypothyroidism, inflammatory bowel disease, Wegener granulomatosis, spondyloarthropathies
    • Sarcoidosis
  • Medication-induced: dantrolene, doxorubicin, hydralazine, isoniazid, mesalamine, methysergide, penicillin, phenytoin, procainamide, rifampin

Genetics
No known factors

Commonly Associated Conditions

Depends on etiology

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