Pericarditis

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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 emergency room (ER) for chest pain without myocardial infarction (MI), including children; appears to be a slightly increased prevalence in men ages 16–65 years old.
  • After first episode of acute pericarditis, about 30% of patients will experience recurrence within next 18 months.

Etiology and Pathophysiology

  • Inflammation of the pericardial sac can be acute, chronic (disease process lasting >3 months), or recurrent (subsequent episode after 4–6 weeks without symptoms). Chronic or 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: Mycobacterium tuberculosis (common in endemic countries), other bacterial causes rare
    • Fungal (more common in immunocompromised populations): Blastomyces dermatitidis, Candida sp., Histoplasma capsulatum
    • 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
    • After cardiac procedures (e.g., catheterization, pacemaker placement, ablation, pericardiotomy)
    • 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

Risk Factors

Thoracic surgery, chronic kidney disease, pneumonia, autoimmune diseases, lung or breast cancer especially if treated with radiation therapy

General Prevention

Good hygiene including hand washing and use of masks

Commonly Associated Conditions

Depends on etiology

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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 emergency room (ER) for chest pain without myocardial infarction (MI), including children; appears to be a slightly increased prevalence in men ages 16–65 years old.
  • After first episode of acute pericarditis, about 30% of patients will experience recurrence within next 18 months.

Etiology and Pathophysiology

  • Inflammation of the pericardial sac can be acute, chronic (disease process lasting >3 months), or recurrent (subsequent episode after 4–6 weeks without symptoms). Chronic or 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: Mycobacterium tuberculosis (common in endemic countries), other bacterial causes rare
    • Fungal (more common in immunocompromised populations): Blastomyces dermatitidis, Candida sp., Histoplasma capsulatum
    • 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
    • After cardiac procedures (e.g., catheterization, pacemaker placement, ablation, pericardiotomy)
    • 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

Risk Factors

Thoracic surgery, chronic kidney disease, pneumonia, autoimmune diseases, lung or breast cancer especially if treated with radiation therapy

General Prevention

Good hygiene including hand washing and use of masks

Commonly Associated Conditions

Depends on etiology

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