Acute Pericarditis
Section snippets
Anatomy and function of pericardium
The pericardium is an avascular sac composed of a double layer. The outer layer (parietal pericardium) is composed of fibrous tissue while the inner layer (visceral pericardium) is composed of mesothelial serous cells. The parietal pericardium is a thick, tough outer sac made of collagenous connective tissue. It is attached to the diaphragm, sternum and the cartilage of the ribs. The parietal pericardium separates the heart from other mediastinal structures. The visceral pericardium is a thin
Epidemiology
Patients should be screened and considered for specific etiology and rational management according to their epidemiological background (Table 2). For example, in developing countries tuberculosis is a major cause. Tuberculosis with HIV infection is common in the sub-Saharan region. In developed countries, idiopathic or pericarditis related to viral infection is more common.16 In contrast, acute pericarditis and myocarditis share many of the same viral etiologies as causative agents and
History
Patients with acute pericarditis present with sudden onset of chest pain, which is sharp in nature and usually in the precordial/retrosternal area. The pain classically worsens with inspiration and is often positional. Pain often increases with supine position and is relieved with sitting posture and leaning forward. Pericarditis may involve the phrenic nerve which innervates the trapezius muscles, resulting in pain in the back and shoulders.26 The pain may radiate to the neck, left shoulder
Idiopathic pericarditis
Idiopathic pericarditis occurs seasonally, typically in the spring and fall and is clinically difficult to separate from viral pericarditis.37
Infectious causes of pericarditis
Viral Infection is the most common cause of acute pericarditis. It occurs with seasonal epidemics. The most common viral infections associated with acute pericarditis are influenza and coxsackie virus B.38
Acute pericarditis secondary to bacterial infection occurs through direct spread from lung infection, traumatic injury, blood seeding from bacterial
Conclusion
Acute pericarditis is a common disease in routine clinical practice. A careful clinical history, physical examination, and application of diagnostic criteria are needed to make an accurate diagnosis, exclude concomitant disease and properly triage patients. Therapy for acute pericarditis should be guided according to the underlying etiology. For common forms of pericarditis such as idiopathic and viral pericarditis, NSAIDs or aspirin with addition of colchicine remains the mainstay of therapy.
Conflict of interest
There are no relevant financial disclosures, acknowledgments or conflicts of interest.
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Cited by (24)
NLRP3-mediated inflammation in cardio-oncology: sterile yet harmful
2023, Translational ResearchCUPS to Manage Pericarditis
2021, Journal for Nurse PractitionersCitation Excerpt :Treatment of acute pericarditis begins with pain relievers, such as NSAIDs, which are commonly chosen due to their anti-inflammatory properties compared with other types of pain relievers.27 NSAIDs result in inflammation reduction and symptom improvement in approximately 70% to 80% of patients with viral or idiopathic pericarditis.7 Even in recurrent cases of pericarditis, NSAIDs remain the mainstay of therapy.16
Acute Pericarditis: Best Practices for Nurse Practitioners
2021, Journal for Nurse PractitionersCitation Excerpt :While safe and effective when used appropriately, colchicine interacts with many medications, including statins, macrolides, and antifungals, which can lead to toxicity.4,5 Other possible side effects of colchicine are bone marrow suppression, hepatoxicity, nephrotoxicity, and myotoxicity with concurrent use of statins.4 A low- to moderate-dose corticosteroid (0.2–0.5 mg/kg/day of prednisone) is the second-line agent for patients who have a contraindication or lack of response to NSAIDs and colchicine but without a known infectious etiology.1
Risk Factors for Morbidity and Mortality Following Hospitalization for Pericarditis
2020, Journal of the American College of CardiologyClinical Update in Pericardial Diseases
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Noninfectious causes of pericarditis derive from autoimmune, neoplastic, metabolic, traumatic, iatrogenic, pharmacologic, and congenital processes. Patients who have no high-risk features or other findings suggestive of a specific underlying cause may be managed medically on an outpatient basis.1,11 Figure 1 outlines the initial management strategy for suspected pericarditis.
Statement of Conflict of Interest: see page 357.