5,421
edits
Pericarditis: Difference between revisions
no edit summary
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
'''Pericarditis''' refers to inflammation of the pericardium. It can be acute, recurrent, or chronic. It often leads to formation of a [[pericardial effusion]]. | '''Pericarditis''' refers to inflammation of the pericardium. It can be acute, recurrent, or chronic. It often leads to formation of a [[pericardial effusion]]. It accounts for up to 5% of patients with chest pain in which [[acute coronary syndrome]] is initially suspected. It more frequently affects men than women. | ||
Pericarditis may occur together with [[myocarditis]], called perimyocarditis or myopericarditis. | |||
The prognosis is good with treatment, but without treatment the disease usually recurs. In non-viral cases, the pericardial effusion may be large enough to cause [[Cardiac tamponade|cardiac tamponade.]] [[Constrictive pericarditis]] may also develop. | |||
== Etiology == | == Etiology == | ||
| Line 11: | Line 15: | ||
** Metastasis | ** Metastasis | ||
** Metabolic disorder | ** Metabolic disorder | ||
** Dressler syndrome | |||
In many cases, the exact etiology cannot be determined, but viral causes are assumed to cause most of these idiopathic cases. | |||
Dressler syndrome is an idiopathic pericarditis occuring weeks after a [[myocardial infarction]]. | |||
== Classification == | == Classification == | ||
| Line 26: | Line 34: | ||
* [[Chest X-ray|X-ray]] – enlarged cardiac silhouette due to [[pericardial effusion]] | * [[Chest X-ray|X-ray]] – enlarged cardiac silhouette due to [[pericardial effusion]] | ||
* [[Electrocardiogram|ECG]] – widespread ST elevation or PR depression | * [[Electrocardiogram|ECG]] – widespread ST elevation or PR depression or T inversion | ||
* [[Echocardiography]] – pericardial effusion and thickened pericardium | * [[Echocardiography]] – pericardial effusion and thickened pericardium. Pericardial effusion occurs in only 2/3 of cases and there are usually only small amounts | ||
* [[Inflammatory marker|Inflammatory markers]] may be elevated | * [[Inflammatory marker|Inflammatory markers]] may be elevated | ||
* Inflammation of the pericardium can be visualised on [[Computer tomography (CT)|CT]] or [[Magnetic resonance imaging (MRI)|MRI]] | * Inflammation of the pericardium can be visualised on [[Computer tomography (CT)|CT]] or [[Magnetic resonance imaging (MRI)|MRI]] | ||
To diagnose acute pericarditis, two of the following features must be present: | |||
* Typical pericardial pain | |||
* Pericardial friction rub | |||
* Typical ECG changes | |||
* Pericardial effusion | |||
== Treatment == | == Treatment == | ||
First-line treatment are [[Non-steroidal anti-inflammatory drug|NSAIDs]] + [[colchicine]] + exercise reduction. Second line are glucocorticoids and other immunosuppressants. In case of chronic pericarditis, pericardiectomy is an option. | First-line treatment are [[Non-steroidal anti-inflammatory drug|NSAIDs]] + [[colchicine]] + exercise reduction. NSAIDs are titrated down or discontinued after 1-2 weeks, while colchicine is continued for 3 months. | ||
Second line are glucocorticoids and other immunosuppressants. Especially [[anakinra]] (anti-IL-1) is shown to be effective. In case of chronic pericarditis, pericardiectomy is an option. | |||
== Complications == | == Complications == | ||