Pericarditis

Pericarditis
An ECG showing pericarditis, with ST elevation in multiple leads and slight reciprocal ST depression in aVR.
SpecialtyCardiology
SymptomsSharp chest pain, better sitting up and worse with lying down, fever[1]
ComplicationsCardiac tamponade, myocarditis, constrictive pericarditis[1][2]
Usual onsetTypically sudden[1]
DurationFew days to weeks[3]
CausesViral infection, tuberculosis, uremic pericarditis, following a heart attack, cancer, autoimmune disorders, chest trauma[4][5]
Diagnostic methodBased on symptoms, electrocardiogram, fluid around the heart[6]
Differential diagnosisHeart attack[1]
TreatmentNSAIDs, colchicine, corticosteroids[6]
PrognosisUsually good[6][7]
Frequency3 per 10,000 per year[2]

Pericarditis is inflammation of the pericardium, the fibrous sac surrounding the heart.[8] Symptoms typically include sudden onset of sharp chest pain, which may also be felt in the shoulders, neck, or back.[1] The pain is typically less severe when sitting up and more severe when lying down or breathing deeply.[1] Other symptoms of pericarditis can include fever, weakness, palpitations, and shortness of breath.[1] The onset of symptoms can occasionally be gradual rather than sudden.[8]

The cause of pericarditis often remains unknown but is believed to be most often due to a viral infection.[4][8] Other causes include bacterial infections such as tuberculosis, uremic pericarditis, heart attack, cancer, autoimmune disorders, and chest trauma.[4][5] Diagnosis is based on the presence of chest pain, a pericardial rub, specific electrocardiogram (ECG) changes, and fluid around the heart.[6] A heart attack may produce similar symptoms to pericarditis.[1]

Treatment in most cases is with NSAIDs and possibly the anti-inflammatory medication colchicine.[6] Steroids may be used if these are not appropriate.[6] Symptoms usually improve in a few days to weeks but can occasionally last months.[3] Complications can include cardiac tamponade, myocarditis, and constrictive pericarditis.[1][2] Pericarditis is an uncommon cause of chest pain.[9] About 3 per 10,000 people are affected per year.[2] Those most commonly affected are males between the ages of 20 and 50.[10] Up to 30% of those affected have more than one episode.[10]

  1. ^ a b c d e f g h i "What Are the Signs and Symptoms of Pericarditis?". National Heart, Lung, and Blood Institute. September 26, 2012. Archived from the original on 2 October 2016. Retrieved 28 September 2016.
  2. ^ a b c d Imazio M, Gaita F (July 2015). "Diagnosis and treatment of pericarditis". Heart. 101 (14): 1159–68. doi:10.1136/heartjnl-2014-306362. PMID 25855795. S2CID 35310104.
  3. ^ a b "How Is Pericarditis Treated?". National Heart, Lung, and Blood Institute. September 26, 2012. Archived from the original on 2 October 2016. Retrieved 28 September 2016.
  4. ^ a b c Tingle LE, Molina D, Calvert CW (November 2007). "Acute pericarditis". American Family Physician. 76 (10): 1509–14. PMID 18052017.
  5. ^ a b "What Causes Pericarditis?". National Heart, Lung, and Blood Institute. September 26, 2012. Archived from the original on 2 October 2016. Retrieved 28 September 2016.
  6. ^ a b c d e f Imazio M, Gaita F, LeWinter M (October 2015). "Evaluation and Treatment of Pericarditis: A Systematic Review". JAMA. 314 (14): 1498–506. doi:10.1001/jama.2015.12763. hdl:2318/1576078. PMID 26461998.
  7. ^ Cunha BA (2010). Antibiotic Essentials. Jones & Bartlett Publishers. p. 71. ISBN 978-1-4496-1870-4.
  8. ^ a b c "What Is Pericarditis?". National Heart, Lung, and Blood Institute. September 26, 2012. Archived from the original on October 2, 2016.
  9. ^ McConaghy JR, Oza RS (February 2013). "Outpatient diagnosis of acute chest pain in adults". American Family Physician. 87 (3): 177–82. PMID 23418761.
  10. ^ a b "Who Is at Risk for Pericarditis?". National Heart, Lung, and Blood Institute. September 26, 2012. Archived from the original on 2 October 2016. Retrieved 28 September 2016.