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Revision as of 14:28, 18 August 2011

Pericarditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pericarditis can present as a disorder primarily involving the pericardium (e.g viral etiologies), as manifestation of a systemic illness (e.g. autoimmune illnesses), or as a manifestation of a disorder involving an adjacent anatomic structure (e.g. cancer).

Common Causes of Pericarditis [1]

Complete Differential Diagnosis of the Causes of Pericarditis

(By organ system)

Cardiovascular Post-MI pericarditis in the immediate days following acute MI and Dresslers syndrome which develops later; dissecting aortic aneurysm; endocarditis and underlying myocarditis.

Following cardiovascular procedures such as: cathether ablation for arrhythmias, coronary artery bypass grafting (CABG) (postpericardiotomy syndrome), pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium), valvuloplasty.

Chemical / poisoning Silicosis
Dermatologic Behcet syndrome
Drug Side Effect Usually associated with small effusions. Common culprits include hydralazine, procainamide, DOH, isoniazid, phenylbutazone, dantrolene, doxorubicin, methylsergide, penicillin.
Ear Nose Throat Temporal arteritis
Endocrine Usually in conjunction with clinically severe hypothyroidism. Most early case reports associated with myxedema and patients also had ascites, pleural effusions and uveal edema. Often resolves with thyroid replacement therapy. A pericardial effusion can be seen as part of an Addisonian crisis.
Environmental No underlying causes
Gastroenterologic Inflammatory bowel disease, Whipple's
Genetic Gaucher disease, Jacobs arthropathy-camptodactyly syndrome, Mulibrey nanism syndrome, Recurrent hereditary polyserositis
Hematologic Leukemia, Lymphoma
Iatrogenic Chylopericardium (from thoracic duct obstruction secondary to tumor, surgical procedure), Cardiopulmonary resuscitation, Postpericardiotomy syndrome, Radiation therapy, Serum sickness
Infectious Disease

Bacterial: Pneumococcus, Streptococcus and Staphylococcus are most common. Also Borrelia,Brucellosis, E.coli, Francisella, Haemophilus influenza, Klebsiella, Legionella(preodominantly by hematogenous spread and approximately 20% by contiguous spread. Usually these patients are quite ill), Meningococci, Neisseria, Proteus, Psuedomonas, Salmonella, Tularemia.

Fungal: Actinomycosis, Amebiasis, Aspergillus, Blastomycosis, Candida, Coccidiomycosis,Echinococcus, Histoplasmosis, Nocardia, Toxoplasmosis.

Helminthic: Alveolar hydatid disease

Protozoal: Entamoeba histolytica

Tuberculous: usually bloody, protein greater than 2.5. Initially mostly polymorphonuclear cells, later lymphocytes, monocytes and plasma cells. Usually develops very slowly with significant fibrous reaction. Initially effusive then becomes constrictive. OtherMycoplasma such as mycoplasma pnuemonia can cause pericarditis is well.

Viral: Coxsackie B Virus, Echovirus, Adenovirus (less commonly: CMV-especially in HIV patients, EBV, Hepatitis B, Influenza, Mumps, Varicella).

Other: , Lyme disease (usually myopericarditis associated with conduction abnormalities). Rickettsia

Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Predominantly lung cancer, breast cancer, leukemia, lymphomas (Hodgkins and non-Hodgkins). Less commonly GI malignancies, ovarian cancer, sarcomas and melanomas, metastic, hematogenous, carcinoma, carcinoid, Sipple syndrome, mesothelioma, fibroma, lipoma . Also Kaposis sarcoma in HIV positive patients.
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal / Electrolyte Uremic pericarditis is seen in up to 20% of uremic patients requiring chronic hemodialysis. The mechanism is unknown. Most commonly there is a small effusion associated with pain and a pericardial friction rub, but there can be a large effusion and present with tamponade
Rheum / Immune / Allergy Systemic Lupus Erythematosus or SLE: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate (ESR) , +ANA, +dsDNA, pleural effusions). Occurs in 20-40% of patients with SLE during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically WBC count is less than 10K, and is made up of primarily polymorphonuclear cells (PMNs).

Rheumatoid arthritis or RA: Pericarditis can occur without active joint involvement. Also serous or bloody. Usually the protein is > 5 mg/dl, and the glucose is low (<45). The WBC is high at 20-90K. Complement is usually low, and the latex fixation test is usually positive.

Other: Amyloidosis, Ankylosing Spondylitis, Behcet syndrome, Familial Mediterranian Fever, Kawasaki disease, Mixed Connective Tissue Disease, Polyarteritis nodosa PAN, Polymyositis,Reiter's Syndrome, acute Rheumatic fever, Sarcoidosis, Scleroderma, Still disease, Systemic sclerosis, Temporal arteritis and , Wegener's.

Sexual Neisseria gonorrhoeae, Treponema pallidum
Trauma After blunt or penetrating chest trauma

Following cardiovascular procedures such as: cathether ablation for arrhythmias, pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium, valvuloplasty.

Following gastrointestinal catastrophes including esophageal rupture, pancreatic-pericardial fistula, esophogeal perforation, gastric perforation.

Urologic Renal Failure, Uremia
Miscellaneous Commonly the diagnosis is idiopathic.

Differential Diagnosis of Causes of Acute Pericarditis

In alphabetical order:

Differential Diagnosis of Causes of Chronic Pericarditis

In alphabetical order:

References

  1. Maisch B, Ristic AD (2002). "The classification of pericardial disease in the age of modern medicine". Curr Cardiol Rep. 4 (1): 13–21. doi:10.1007/s11886-002-0121-6. PMID 11743917.

Cateogry:Up to date cardiology

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