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Journal of the American College of... Jan 2020Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by... (Review)
Review
Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.
Topics: Acute Disease; Anti-Inflammatory Agents; Cardiac Tamponade; Disease Management; Echocardiography; Electrocardiography; Humans; Pericarditis; Recurrence; Review Literature as Topic; Tomography, X-Ray Computed
PubMed: 31918837
DOI: 10.1016/j.jacc.2019.11.021 -
Current Cardiology Reports Aug 2022Since 2015, when ESC guidelines for the diagnosis and management of pericardial diseases were published, ongoing research has enhanced the current state of knowledge on... (Review)
Review
PURPOSE OF REVIEW
Since 2015, when ESC guidelines for the diagnosis and management of pericardial diseases were published, ongoing research has enhanced the current state of knowledge on acute pericarditis. This review is an update on the latest developments in this field.
RECENT FINDINGS
In recurrent acute pericarditis, autoinflammation has been included among causative mechanisms restricting the vague diagnoses of "idiopathic" pericarditis. Cardiac magnetic resonance that detects ongoing pericardial inflammation may guide treatment in difficult-to-treat patients. Development of risk scores may assist identification of patients at high risk for complicated pericarditis, who should be closely monitored and aggressively treated. Treatment with IL-1 inhibitors has been proven efficacious in recurrent forms with a good safety profile. Finally, acute pericarditis has recently attracted great interest as it has been reported among side effects post COVID-19 vaccination and may also complicate SARS-CoV-2 infection. Recent advancements in acute pericarditis have contributed to a better understanding of the disease allowing a tailored to the individual patient approach. However, there are still unsolved questions that require further research.
Topics: COVID-19; COVID-19 Vaccines; Humans; Pericarditis; Pericardium; SARS-CoV-2
PubMed: 35595949
DOI: 10.1007/s11886-022-01710-8 -
Current Cardiology Reports Jan 2020This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of... (Review)
Review
PURPOSE OF REVIEW
This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials.
RECENT FINDINGS
A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting host-directed immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes.
Topics: Antitubercular Agents; Disease Management; Humans; Pericardial Effusion; Pericarditis, Constrictive; Pericarditis, Tuberculous; Pericardium
PubMed: 31940097
DOI: 10.1007/s11886-020-1254-1 -
Current Cardiology Reports Mar 2023While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation,... (Review)
Review
PURPOSE OF REVIEW
While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis.
RECENT FINDINGS
We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis.
CASE VIGNETTE
A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
Topics: Child; Humans; Male; Chest Pain; COVID-19; Pandemics; Pericardial Effusion; Pericarditis
PubMed: 36749541
DOI: 10.1007/s11886-023-01839-0 -
Progress in Cardiovascular Diseases 2017Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually...
Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder. In routine clinical practice, acute pericarditis can be associated with myocarditis due to their overlapping etiologies.
Topics: Acute Disease; Diagnosis, Differential; Electrocardiography; Humans; Pericarditis; Pericardium; Prognosis
PubMed: 27956197
DOI: 10.1016/j.pcad.2016.12.001 -
Tidsskrift For Den Norske Laegeforening... May 2023Pericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and...
Pericarditis is an important differential diagnosis in patients with chest pain. The two most common causes in the developed world are idiopathic pericarditis and inflammation following cardiac surgery or myocardial infarction. Recurrence of pericarditis affects up to 30 % of patients, half of whom experience multiple episodes, and approximately 10 % develop steroid-dependent and colchicine-refractory pericarditis. Recurrence is due to autoinflammatory processes in the pericardium. Advanced diagnostic imaging and treatment with colchicine and interleukin-1 inhibitors has helped reduce morbidity considerably in recent years. In this clinical review, we summarise up-to-date knowledge about the diagnostic evaluation and treatment of patients with recurrent primary pericarditis.
Topics: Humans; Pericarditis; Colchicine; Myocardial Infarction; Inflammation; Recurrence
PubMed: 37254974
DOI: 10.4045/tidsskr.22.0580 -
Australian Family Physician Nov 2017Pericarditis is an important diagnosis to consider, along with various other differential diagnoses, in a patient who presents with chest pain.
BACKGROUND
Pericarditis is an important diagnosis to consider, along with various other differential diagnoses, in a patient who presents with chest pain.
OBJECTIVE
This article describes in detail the common features, management and complications of pericarditis in the general practice setting.
DISCUSSION
Characteristic clinical findings in pericarditis include pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border. Electrocardiography may reveal diffuse PR-segment depressions and diffuse ST-segment elevations with upward concavity. The most common aetiologies of pericarditis are idiopathic and viral, and the most common treatment for these are nonsteroidal anti-inflammatory drugs and colchicine. The complications of pericarditis include pericardial effusion, tamponade and myopericarditis. The presence of effusion, constriction or tamponade can be confirmed on echocardiography. Tamponade is potentially life-threatening and is diagnosed by the clinical findings of decreased blood pressure, elevated jugular venous pressure, muffled heart sounds on auscultation and pulsus paradoxus.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Chest Pain; Diagnosis, Differential; Electrocardiography; Friction; Humans; Pericarditis
PubMed: 29101915
DOI: No ID Found -
The Pan African Medical Journal 2022Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy....
Purulent pericarditis is an infection of the pericardial space that produces pus that is found on gross examination of the pericardial sac or on the tissue microscopy. In this case report, we will discuss a 31-year-old male who presented with a chief complaint of low-grade fevers, dry cough and difficulty breathing for about two weeks which preceded after removing of dental also two weeks prior. He was admitted and treated as COVID-19 in the isolation ward, he later developed cardiac tamponade and during pericardiocentesis thick pus was discharged. Pus culture and Gene Xpert tests were all negative. After his condition improved, the patient was transferred to the general ward with the pericardial window still discharging pus. Pericardiectomy was chosen as definitive management. The key takeaway in this report is that Empirical treatment with RHZE (rifampin, isoniazid, pyrazinamide, and ethambutol) in resource-limited settings is recommended due to difficulty in identifying the exact cause at a required moment.
Topics: Adult; COVID-19; Ethambutol; Humans; Isoniazid; Male; Mediastinitis; Pericarditis; Pericardium; Pyrazinamide; Rifampin; Sclerosis; Suppuration
PubMed: 36160276
DOI: 10.11604/pamj.2022.42.145.34018 -
La Revue Du Praticien Jan 2021"Pericarditis Acute pericarditis is a common disease, most often idiopathic or viral. This is usually a mild condition but recurrences are frequent. The predominant... (Review)
Review
"Pericarditis Acute pericarditis is a common disease, most often idiopathic or viral. This is usually a mild condition but recurrences are frequent. The predominant pathophysiological hypothesis is that of underlying dysimmune disorders, involving an inflammatory response of the innate immune system typical of "autoinflammatory diseases", mainly mediated by interleukin-1 [IL-1] with activation of inflammasome; and an adaptive immune system response, typical of «autoimmune diseases», primarily mediated by autoantibodies and autoreactive T cells. The clinical picture associates fever, chest pain, changes in the electrocardiogram and possible pericardial effusion. Treatment is based on the combination of aspirin/nonsteroidal anti-inflammatory drugs and colchicine for several weeks. In refractory pericarditis, low dose corticosteroid therapy and / or immunosuppressive agents have been proposed with limited efficacy. Growing evidency suggest a place for IL-1 receptor antagonists in the treatment of recurrent pericarditis. Many studies have shown the effectiveness of anakinra with a good safety profile. Other IL-1 receptor antagonists have shown promising results (canakinumab, rilonacept). Further evaluation in larger prospective clinical trials is needed to confirm the long-term efficacy and safety of anti-IL1."
Topics: Aspirin; Colchicine; Humans; Interleukin 1 Receptor Antagonist Protein; Pericarditis; Prospective Studies; Recurrence
PubMed: 34160952
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... 2015Acute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and self-limited and can occur as an isolated or as a manifestation of a... (Review)
Review
Acute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and self-limited and can occur as an isolated or as a manifestation of a systemic disease entity. Represents 5% of all causes of chest pain in the emergency room. The main etiology are viral infections, although it can also be secondary to systemic diseases and infections. The main complication of acute pericarditis is pericardial effusion, triggering a cardiac tamponade. The first line of treatment is the use of anti-inflammatory and or acetylsalicylic acid. Most patients have a good initial response to an NSAID associated to colchicine and became asymptomatic within a few days. This review article seeks to contemplate the main clinical findings and armed investigation to optimize the diagnosis of this important disease, as well as addressing their therapeutic management.
Topics: Acute Disease; Anti-Inflammatory Agents, Non-Steroidal; Colchicine; Electrocardiography; Female; Humans; Male; Pericardial Effusion; Pericarditis; Risk Factors; Tomography, X-Ray Computed
PubMed: 26107370
DOI: 10.1590/1806-9282.61.02.184