From the Guidelines
Pericarditis is primarily caused by viral infections, particularly coxsackieviruses, echoviruses, and influenza viruses, as well as other factors such as bacterial infections, autoimmune disorders, and certain medical conditions. The causes of pericarditis can be diverse and include:
- Viral infections, such as coxsackieviruses, echoviruses, and influenza viruses 1
- Bacterial infections, such as tuberculosis and Staphylococcus 1
- Autoimmune disorders, like lupus and rheumatoid arthritis 1
- Myocardial infarction (heart attack) 1
- Trauma to the chest 1
- Certain medications, including some antibiotics and chemotherapy drugs 1
- Radiation therapy to the chest 1
- Kidney failure with uremia 1
- Some cancers that spread to the pericardium 1 In many cases, pericarditis is idiopathic, meaning no specific cause can be identified 1. The inflammation occurs when the body's immune system responds to an injury or infection affecting the pericardium, the thin sac surrounding the heart. This immune response leads to inflammation, which causes the characteristic chest pain, friction rub heard on auscultation, and sometimes fluid accumulation around the heart (pericardial effusion) 1. Understanding the underlying cause is essential for proper treatment, as management approaches vary depending on whether the condition is infectious, autoimmune, or related to another medical condition 1.
From the Research
Pericarditis Causes and Treatment
- Pericarditis is a common cause of nonischemic chest pain, accounting for up to 5% of emergency department visits in North America and Western Europe 2.
- The most common causes of acute pericarditis are idiopathic or viral, followed by pericarditis after cardiac procedures or operations 2.
- In endemic areas, tuberculosis is the most common cause of pericarditis, and is treated with antituberculosis therapy, with corticosteroids considered for associated constrictive pericarditis 2.
Symptoms and Diagnosis
- Acute pericarditis is diagnosed with the presence of 2 or more of the following: sharp, pleuritic chest pain that worsens when supine, new widespread electrocardiographic ST-segment elevation and PR depression, a new or increased pericardial effusion, or a pericardial friction rub 2.
- The development of constrictive pericarditis and pericardial tamponade can be life-threatening in acute pericarditis 2.
Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy for acute and recurrent pericarditis, with colchicine often used as an adjunct to relieve symptoms and reduce the risk of recurrence 3, 2, 4, 5, 6.
- Corticosteroids are often used if pericarditis does not improve with NSAIDs and colchicine, and may be considered for specific medical conditions such as systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy 3, 2, 5.
- Interleukin 1 (IL-1) blockers have demonstrated efficacy in patients with multiple recurrences of pericarditis and may be preferred to corticosteroids in certain cases 2, 5, 6.