Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart). Pericarditis is further classified according to the
composition of the inflammatory exudate: serous, purulent, fibrinous, and hemorrhagic types are
distinguished (images).
Acute pericarditis is more common than chronic pericarditis, and can occur as a
complication of infections, immunologic conditions, or heart attack.
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, and vice versa.
The classic sign of pericarditis is a friction rub. Other signs include ST-elevation and PR-depression on EKG (all leads); cardiac tamponade (pulsus paradoxus with hypotension), and congestive heart failure (elevated jugular venous
pressure with peripheral edema).
Pathophysiology
Causes
Complications
Most cases of acute idiopathic pericarditis resolve without complications or recurrence. Complications may include:
Fibrinous pericarditis
Fibrinous pericarditis is an exudative inflammation.
The pericardium is infiltrated by the fibrinous exudate. This consists of fibrin strands and
leukocytes. Fibrin describes an amorphous, eosinophilic (pink) network. Leukocytes (mainly neutrophils) are found within the fibrin deposits and intrapericardic. Vascular congestion is
also present. The myocardium has no changes. Photo at: Atlas of Pathology
Pericarditis due to Tuberculosis
Pericarditis caused by tuberculosis is difficult to diagnose, because definitive
diagnosis requires culturing Mycobacterium tuberculosis from aspirated
pericardial fluid or pericardial biopsy, which requires high technical skill and is often not diagnostic (the yield from culture is low
even with optimum specimens). The Tygerberg scoring system helps the clinician to decide
whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point),
fever (2 point), serum globulin > 40g/l (3 points), blood total leucocyte count <10 x 109/l (3 points); a total
score of 6 or more is highly suggestive of tuberculous pericarditis.[1] Pericardial fluid with an interferon-γ level greater than
50pg/ml is highly specific for tuberculous
pericarditis.
Treatment
The treatment in viral or idiopathic pericarditis is with non-steroidal
anti-inflammatory drugs. Severe cases may require:
References
- ^ Reuter H, Burgess L, van Vuuren W, Doubell
A. (2006). "Diagnosing tuberculous pericarditis". Q J Med 99: 827–39. PMID 17121764.
External links
|
Circulatory system pathology (I, 390-459) |
| Hypertension |
Hypertensive heart
disease - Hypertensive nephropathy - Secondary hypertension (Renovascular
hypertension) |
| Ischaemic heart disease |
Angina
pectoris (Prinzmetal's angina) - Myocardial infarction - Dressler's syndrome |
| Pulmonary circulation |
Pulmonary embolism
- Cor pulmonale |
| Pericardium |
Pericarditis - Pericardial effusion - Cardiac tamponade |
| Endocardium/heart valves |
Endocarditis -
mitral valves (regurgitation,
prolapse, stenosis) - aortic valves (stenosis, insufficiency) - pulmonary valves (stenosis, insufficiency) -
tricuspid valves (stenosis,
insufficiency) |
| Myocardium |
Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic
cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia |
Electrical conduction system
of the heart |
Heart block:
AV block (First degree,
Second degree, Third degree) -
Bundle branch block (Left,
Right) - Bifascicular block -
Trifascicular block
Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome -
Adams-Stokes syndrome - Cardiac
arrest
Arrhythmia: Paroxysmal tachycardia
(Supraventricular, AV
nodal reentrant, Ventricular) - Atrial
flutter - Atrial fibrillation - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) -
Sick sinus syndrome |
| Other heart conditions |
Heart
failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right) |
| Cerebrovascular diseases |
Intracranial
hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage,
Subdural hemorrhage, Subarachnoid
hemorrhage) - Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior
spinal artery syndrome - Binswanger's disease - Moyamoya disease |
Arteries, arterioles
and capillaries |
Atherosclerosis (Renal artery stenosis) -
Aortic dissection/Aortic aneurysm
(Abdominal aortic aneurysm) - Aneurysm -
Raynaud's phenomenon/Raynaud's disease -
Buerger's disease - Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary
hemorrhagic telangiectasia - Spider angioma |
Veins,
lymphatic vessels
and lymph nodes |
Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome,
Portal vein thrombosis, Venous
thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease)
- Varicose veins (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph(Lymphadenitis, Lymphedema, Lymphangitis) |
| See also congenital (Q20-Q28, 745-747) |
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