Idiopathic

 

Viral,

Bacterial

Fungal

heart attack or heart surgery

Injuries

Medications

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Due to systemic diseases (autoimmune syndromes, uremia), neoplasm, radiation, drug toxicity, hemopericardium, postcardiac surgery, or contiguous inflammatory processes in the myocardium or lung.

In many of these conditions, the pathologic process involves both the pericardium and the myocardium.

Overall pericarditis accounts for 0.2% of hospital admissions and about 5% of patients with nonischemic chest pain seen in the emergency department. The ESC in 2015 proposed four definitions for pericarditis and elucidated diagnostic criteria for each (Table 10–19). 

Viral infections (especially infections with coxsackieviruses and echoviruses but also influenza, Epstein-Barr, varicella, hepatitis, mumps, and HIV viruses) are the most common cause of acute pericarditis and probably are responsible for many cases classified as idiopathic. Males—usually under age 50 years—are most commonly affected. The differential diagnosis primarily requires exclusion of acute MI. Tuberculous pericarditis is rare in developed countries but remains common in certain areas of the world. It results from direct lymphatic or hematogenous spread; clinical pulmonary involvement may be absent or minor, although associated pleural effusions are common. Bacterial pericarditis is equally rare and usually results from direct extension from pulmonary infections. Pneumococci, though, can cause a primary pericardial infection. Borrelia burgdorferi, the organism responsible for Lyme disease, can also cause myopericarditis (and occasionally heart block). Uremic pericarditis is a common complication of chronic kidney disease. The pathogenesis is uncertain; it occurs both with untreated uremia and in otherwise stable dialysis patients. Spread of adjacent lung cancer as well as invasion by breast cancer, renal cell carcinoma, Hodgkin disease, and lymphomas are the most common neoplastic processes involving the pericardium and have become the most frequent causes of pericardial tamponade in many countries. Pericarditis may occur 2–5 days after infarction due to an inflammatory reaction to transmural myocardial necrosis (post-MI or postcardiotomy pericarditis [Dressler syndrome]). Radiation can initiate a fibrinous and fibrotic process in the pericardium, presenting as subacute pericarditis or constriction. Radiation pericarditis usually follows treatments of more than 4000 cGy delivered to ports including more than 30% of the heart.

 

• Inflammation of the pericardium (e.g. following viral infection) produces characteristic chest pain (retrosternal, pleuritic, worse on lying flat, relieved by sitting forward), tachycardia and dyspnoea.
• There may be an associated pericardial friction rub or evidence of a pericardial effusion.

 

Other causes of pericarditis include connective tissue diseases, such as lupus erythematosus and rheumatoid arthritis, drug-induced pericarditis (minoxidil, penicillins, clozapine), and myxedema. In addition, pericarditis may result from pericardial injury from invasive cardiac procedures (such as cardiac pacemaker and defibrillator perforation and intracardiac ablation, especially atrial fibrillation ablation), and the implantation of intracardiac devices (such as ASD occluder devices).

Pericarditis and myocarditis may coexist in 20–30% of patients. Myocarditis is often suspected when there is an elevation of serum troponins, although there are no data that suggest troponin elevations are associated with a poor prognosis.

 

 

colchicine to NSAIDs during the first episode of pericarditis may decrease the chance of recurrence. ¹

duration of treatment depends on the patient’s symptoms.

Glucocorticoids should be avoided unless NSAIDs are absolutely contraindicated or if the underlying disease mechanism requires their use; for example, in SLE or rheumatoid arthritis. If acute myocardial infarction is the underlying cause, the anti-inflammatory of choice is obviously aspirin.