Elsevier

Progress in Cardiovascular Diseases

Volume 59, Issue 4, January–February 2017, Pages 349-359
Progress in Cardiovascular Diseases

Acute Pericarditis

https://doi.org/10.1016/j.pcad.2016.12.001Get rights and content

Abstract

Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder. In routine clinical practice, acute pericarditis can be associated with myocarditis due to their overlapping etiologies.

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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    Statement of Conflict of Interest: see page 357.

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