From the Guidelines
Pericarditis in a 43-year-old female with congestive heart failure (CHF) and chronic kidney disease (CKD) is most likely caused by uremia from advanced kidney disease, as evidenced by the high incidence of uremic pericarditis in patients with end-stage renal disease (ESRD) 1. The patient's underlying conditions, such as CHF and CKD, increase the risk of developing pericarditis due to various factors, including:
- Uremic pericarditis, which occurs when waste products accumulate in the blood due to kidney dysfunction, causing inflammation of the pericardium 1
- Viral infections, such as coxsackievirus, echovirus, or adenovirus, which can trigger pericarditis even in patients with comorbidities
- Autoimmune conditions, such as systemic lupus erythematosus or rheumatoid arthritis, which may cause pericardial inflammation, particularly in middle-aged women
- Medication-induced pericarditis, which could result from drugs commonly used in CHF or CKD management, including hydralazine, procainamide, or certain diuretics To determine the specific cause of pericarditis, a diagnostic workup should include:
- Echocardiogram to assess pericardial effusion and cardiac function
- ECG to evaluate for signs of pericarditis, such as ST-segment elevation
- Inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), to assess the level of inflammation
- Viral studies to identify potential viral causes
- Assessment of kidney function to evaluate the severity of CKD and potential uremic pericarditis According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases, a triage for acute pericarditis is proposed, which includes hospital admission and an aetiology search for patients with high-risk features, such as high fever, subacute course, large pericardial effusion, cardiac tamponade, and failure to respond to non-steroidal anti-inflammatory drugs (NSAIDs) 1. In patients with uremic pericarditis, specific therapy, such as dialysis, may be indicated to reduce the accumulation of waste products in the blood 1. Overall, the management of pericarditis in this patient should prioritize the identification and treatment of the underlying cause, as well as the reduction of symptoms and prevention of complications.
From the Research
Causes of Pericarditis
The causes of pericarditis can be varied, including:
- Infectious causes, such as viral and bacterial infections 2, 3, 4
- Noninfectious causes, such as systemic inflammatory diseases, cancer, and post-cardiac injury syndromes 2, 3, 4
- Uremic pericarditis, which is caused by the accumulation of uremic toxins in patients with chronic kidney disease (CKD) 5, 6
- Idiopathic causes, which are the most common type of pericarditis in developed countries 2, 3
Pericarditis in Patients with CHF and CKD
In patients with congestive heart failure (CHF) and CKD, the causes of pericarditis may include:
- Uremic pericarditis, which is a common cause of pericarditis in patients with end-stage renal disease 5, 6
- Idiopathic pericarditis, which can occur in patients with CHF and CKD 2, 3
- Infectious pericarditis, which can occur in patients with CHF and CKD, especially in those with impaired immune function 2, 3, 4
Diagnosis and Treatment
The diagnosis of pericarditis is based on clinical criteria, including:
- Chest pain 2, 3, 4
- Pericardial rub 2, 3, 4
- Electrocardiographic changes 2, 3, 4
- Pericardial effusion 2, 3, 4 The treatment of pericarditis typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine 2, 3, 4. In patients with uremic pericarditis, hemodialysis may be necessary to remove uremic toxins 5, 6.