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

• Incidence is approximately 27.7 cases per 100,000 per year (1).
• After the 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, incessant, chronic, or recurrent (2).
• Can lead to production of serous/purulent fluid/dense fibrinous material, 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 (80–85% of cases): coxsackievirus, echovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, hepatitis viruses, influenza virus, HIV, measles, mumps, varicella, SARS-CoV-2 (1.5% of cases), parvovirus B19
  • Bacterial: Mycobacterium tuberculosis (common in endemic countries); fungal (more common in immunocompromised populations): Blastomyces dermatitidis, Candida sp., Histoplasma capsulatum; parasites: Echinococcus
• Noninfectious causes (15–20% of cases)
  • 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, IgG4-related disease
  • Suspected vaccination associations: smallpox, influenza, SARS-CoV-2 mRNA vaccine (incidence of ~4.8 per 1 million)
• Medication-induced: dantrolene, doxorubicin, hydralazine, isoniazid, mesalamine, methysergide, penicillin, phenytoin, procainamide, rifampin

Genetics
Familial Mediterranean fever, tumor necrosis factor receptor-associated periodic syndrome (TRAPS) both particularly related to recurrent pericarditis (3)

Risk Factors

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