Pericarditis
Classification and external resources
An ECG showing pericarditis. Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR.
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).

[edit] Classification

Pericarditis can be classified according to the composition of the inflammatory exudate.^[1]

Types include:

• serous
• purulent
• fibrinous
• caseous
• hemorrhagic

Pericardiocentesis can be performed to permit analysis of the pericardial fluid.

[edit] 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)

[edit] Clinical presentation

Chest pain, radiating to the back and relieved by sitting up forward and worsened by lying down, 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.

[edit] Causes

[edit] 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.

[edit] Other

• Idiopathic: No identifiable etiology found after routine testing.
• Immunologic conditions including 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

[edit] Pathophysiology

[edit] Complications

Most cases of acute idiopathic pericarditis resolve without complications or recurrence. Complications may include:

• Pericardial effusion
• Constrictive pericarditis
• Cardiac tamponade [1]

[edit] 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

[edit] References

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (December 2007)

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

[edit] External links

• Pericarditis - Cleveland Clinic
• Pericarditis - National Library of Medicine
• Pericarditis - National Heart Lung Blood Institute