Pericarditis 684786 224322040 2008-07-08T09:52:34Z StigBot 5316354 robot Adding: [[no:Perikarditt]] {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 9820 | ICD10 = {{ICD10|I|01|0|i|00}}, {{ICD10|I|09|2|i|05}}, {{ICD10|I|30||i|30}}-{{ICD10|I|32||i|30}} | ICD9 = {{ICD9|420.90}} | ICDO = | OMIM = | MedlinePlus = 000182 | eMedicineSubj = med | eMedicineTopic = 1781 | eMedicine_mult = {{eMedicine2|emerg|412}} | MeshName = Pericarditis | MeshNumber = C14.280.720 | }} '''Pericarditis''' is an [[inflammation]] (''-itis'') of the [[pericardium]] (the fibrous sac surrounding the heart). Pericarditis is further classified according to the composition of the inflammatory [[exudate]]: serous, purulent, fibrinous, and hemorrhagic types are distinguished.<ref>[http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html images]</ref> [[Acute pericarditis]] is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or heart attack. == Clinical presentation == [[Chest pain]], radiating to the back and relieved by sitting up forward and worsened by lying down, is the classical presentation. Other symptoms of pericarditis may include dry [[cough]], [[fever]], fatigue and [[anxiety]]. Pericarditis can be misdiagnosed as [[myocardial infarction]] (heart attack), and vice versa. The classic [[medical sign|sign]] of pericarditis is a [[pericardial rub|friction rub]]. Other signs include diffuse ST-elevation and PR-depression on [[Electrocardiogram|EKG]] (all leads); [[cardiac tamponade]] ([[pulsus paradoxus]] with [[hypotension]]), and [[congestive heart failure]] (elevated [[jugular venous pressure]] with [[peripheral edema]]). == Pathophysiology == ===Causes=== * Idiopathic No identifiable etiology found after routine testing. * [[virus|Viral]] infection, especially by [[Coxsackie virus]] (most common cause) * Bacterial infection, especially by the [[Tuberculosis]] bacillus * Fungal * [[Immune mediated inflammatory diseases|Immunologic]] conditions including [[Lupus erythematosus]] (more common among women) * [[Myocardial Infarction]] ([[Dressler's syndrome]]) * [[Physical trauma|Trauma]] to the heart, e.g. puncture, resulting in infection or inflammation * [[Uremia]] * [[Malignancy]] (as a [[paraneoplastic phenomenon]]) * [[Adverse drug reaction|Side effect]] of some [[medications]], e.g. [[isoniazid]], [[cyclosporine]], [[hydralazine]] * Radiation induced * [[Aortic dissection]] * [[Tetracycline antibiotics|Tetracyclines]] * Postpericardiotomy syndrome ===Complications=== Most cases of acute idiopathic pericarditis resolve without complications or recurrence. Complications may include: * [[Pericardial effusion]] * [[Constrictive pericarditis]] * [[Cardiac tamponade]] [http://www.mayoclinic.com/invoke.cfm?objectid=CE3BC2CF-B4C1-4401-8F0F9E0B7C284538&dsection=6] ===Fibrinous pericarditis=== Fibrinous pericarditis is an [[exudative]] [[inflammation]]. The pericardium is infiltrated by the fibrinous exudate. This consists of [[fibrin]] strands and [[leukocytes]]. Fibrin describes an amorphous, [[eosinophilic]] (pink) network. Leukocytes (mainly [[neutrophils]]) are found within the fibrin deposits and intrapericardic. Vascular congestion is also present. The myocardium has no changes. Sometimes referred to as having "Bread and Butter Appearance". Photo at: [http://www.pathologyatlas.ro/Fibrinous%20Pericarditis.html Atlas of Pathology] ===Pericarditis due to Tuberculosis=== Pericarditis caused by [[tuberculosis]] is difficult to diagnose, because definitive diagnosis requires culturing ''[[Mycobacterium tuberculosis]]'' from aspirated [[pericardium|pericardial]] fluid or pericardial [[Wiktionary:biopsy|biopsy]], which requires high technical skill and is often not diagnostic (the yield from culture is low even with optimum specimens). The [[Tygerberg score|Tygerberg scoring system]] helps the clinician to decide whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point), fever (2 point), serum globulin &gt; 40g/l (3 points), blood total leucocyte count &lt;10 x 10<sup>9</sup>/l (3 points); a total score of 6 or more is highly suggestive of tuberculous pericarditis.<ref>{{cite journal | author=Reuter H, Burgess L, van Vuuren W, Doubell A. | title=Diagnosing tuberculous pericarditis | journal=Q J Med | year=2006 | volume=99 | pages=827&ndash;39 | pmid=17121764 }}</ref> Pericardial fluid with an [[interferon-gamma|interferon-γ]] level greater than 50[[Wiktionary:picogram|pg]]/ml is highly specific for tuberculous pericarditis. ==Treatment== The treatment in viral or idiopathic pericarditis is with [[non-steroidal anti-inflammatory drug]]s. Severe cases may require: * [[pericardiocentesis]] * [[antibiotic]]s * [[steroid]]s * [[colchicine]] * [[surgery]] ==References== {{Refimprove|date=December 2007}} <references/> ==External links== * [http://www.mayoclinic.com/invoke.cfm?objectid=CE3BC2CF-B4C1-4401-8F0F9E0B7C284538&dsection=1 Pericarditis] - Mayo Clinic series *[http://cardiologychannel.com/pericarditis/diagnosis.shtml Pericarditis] - cardiologychannel.com * [http://heartcenter.seattlechildrens.org/conditions_treated/pericarditis.asp Pericarditis information] from Seattle Children's Hospital Heart Center *[http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=1;spage=46;epage=9;aulast=Khasnis Pulsus paradoxus] - Journal of Postgraduate Medicine {{Circulatory system pathology}} [[Category:Cardiology]] [[Category:Diseases involving the fasciae]] [[Category:Inflammations]] [[de:Perikarditis]] [[es:Pericarditis]] [[fr:Péricardite]] [[nl:Pericarditis]] [[no:Perikarditt]] [[pl:Zapalenie osierdzia]] [[pt:Pericardite]] [[sv:Hjärtsäcksinflammation]] [[zh:心包炎]]