Pericarditis
| Pericarditis | |
|---|---|
| Classification and external resources | |
 An ECG showing pericarditis. Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR. |
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| ICD-10 | I01.0, I09.2, I30.-I32. |
| ICD-9 | 420.90 |
| DiseasesDB | 9820 |
| MedlinePlus | 000182 |
| eMedicine | med/1781 emerg/412 |
| MeSH | D010493 |
Pericarditis is an inflammation (-itis) of the pericardium (the fibrous sac surrounding the heart).
Contents |
Classification
Pericarditis can be classified according to the composition of the inflammatory exudate.[1]
Types include:
- serous
- purulent
- fibrinous
- caseous
- hemorrhagic
- Post infarction
Pericardiocentesis can be performed to permit analysis of the pericardial fluid.
Acute vs. chronic
Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or heart attack.
One form of chronic pericarditis is constrictive pericarditis.
- Clinically: Acute (<6 weeks), Subacute (6 weeks to 6 months) and Chronic (>6 months)
Clinical presentation
Chest pain, radiating to the back and relieved by sitting up forward and worsened by lying down; pain may also worsen during a deep breath or standing up too quickly, is the classical presentation. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Pericarditis can be misdiagnosed as myocardial infarction (heart attack), and vice versa.
The classic sign of pericarditis is a friction rub. Other signs include diffuse ST-elevation and PR-depression on ECG in all leads except aVR and V1; cardiac tamponade (pulsus paradoxus with hypotension), and congestive heart failure (elevated jugular venous pressure with peripheral edema).
Since the mid-19th Century, retrospective diagnosis of pericarditis has been made upon the finding of adhesions of the pericardium.[2] When pericarditis is diagnosed clinically, the underlying cause is often never known; it may be discovered in only 16[3] to 22[4] percent of patients with acute pericarditis.
Causes
Infectious
Pericarditis may be caused by viral, bacterial, or fungal infection. The most common viral pathogen has traditionally been considered coxsackievirus based on studies in children from the 1960s, but recent data suggest adults are most commonly afflicted with cytomegalovirus, herpesvirus, and HIV.[5][6] Pneumococcus or tuberculous pericarditis are the most common bacterial forms. Fungal pericarditis is usually due to histoplasmosis, or in immunocompromised hosts Aspergillus, Candida, and Coccidioides.
Other
- Idiopathic: No identifiable etiology found after routine testing.
- Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever
- Myocardial Infarction (Dressler's syndrome)
- Trauma to the heart, e.g. puncture, resulting in infection or inflammation
- Uremia (uremic pericarditis)
- Malignancy (as a paraneoplastic phenomenon)
- Side effect of some medications, e.g. isoniazid, cyclosporine, hydralazine
- Radiation induced
- Aortic dissection
- Tetracyclines
- Postpericardiotomy syndrome
Pathophysiology
Complications
Most cases of acute idiopathic pericarditis resolve without complications or recurrence. Complications may include:
- Pericardial effusion
- Constrictive pericarditis
- Cardiac tamponade[7]
Treatment
The treatment in viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs. Severe cases may require:
- pericardiocentesis
- antibiotics
- steroids
- colchicine
- in rare cases, surgery
References
- ↑ images
- ↑ Austin Flint (1862). "Lectures on the diagnosis of diseases of the heart: Lecture VIII". American Medical Times: Being a weekly series of the New York Journal of Medicine 5 (July to December): 309–311.
- ↑ Permanyer-Miralda G; Sagrista-Sauleda J; Soler-Soler J (October 1, 1985). "Primary acute pericardial disease: a prospective series of 231 consecutive patients". American Journal of Cardiology 56 (10): 623–30. doi:10.1016/0002-9149(85)91023-9. PMID 4050698.
- ↑ Zayas R; Anguita M; Torres F; Gimenez D; Bergillos F; Ruiz M; Ciudad M; Gallardo A; Valles F (February 15, 1995). "Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis". American Journal of Cardiology 75 (5): 378–82. doi:10.1016/S0002-9149(99)80558-X. PMID 7856532.
- ↑ AU Corey GR; Campbell PT; Van Trigt P; Kenney RT; O'Connor CM; Sheikh KH; Kisslo JA; Wall TC (August 1993). "Etiology of large pericardial effusions". American Journal of Medicine 95 (2): 209–13. doi:10.1016/0002-9343(93)90262-N. PMID 8356985.
- ↑ Campbell PT; Li JS; Wall TC; O'Connor CM; Van Trigt P; Kenney RT; Melhus O; Corey GR (April 1995). "Cytomegalovirus pericarditis: a case series and review of the literature". American Journal of Medical Science 309 (4): 229–34. doi:10.1097/00000441-199504000-00009. PMID 7900747.
- ↑ mayoclinic.com
General References
- Troughton RW, Asher CR and Klein AL. Pericarditis, Lancet 2004;363:717-27. http://www.ncbi.nlm.nih.gov/pubmed/15001332
- Maisch B, Seferović PM, Ristić AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. European Heart Journal 2004;25:587-610. http://eurheartj.oxfordjournals.org/cgi/content/full/25/7/587
External links
- Pericarditis - Cleveland Clinic
- Pericarditis - National Library of Medicine
- Pericarditis - National Heart Lung Blood Institute
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