Pericarditis
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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Citation
Domino, Frank J., et al., editors. "Pericarditis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116442/all/Pericarditis.
Pericarditis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116442/all/Pericarditis. Accessed December 2, 2023.
Pericarditis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116442/all/Pericarditis
Pericarditis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 December 02]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116442/all/Pericarditis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Pericarditis
ID - 116442
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116442/all/Pericarditis
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -