Pericarditis

Description

Inflammation of the pericardium; this may be associated with other pericardial syndromes including effusion, tamponade, or constrictive pericarditis, and may also involve the myocardium as in myopericarditis or perimyocarditis.

Epidemiology

Etiology and Pathophysiology

• Inflammation of the pericardial sac can be acute, subacute, chronic, or recurrent (2).
• Can lead to production of serous/purulent fluid/dense fibrinous material, which may lead to hemodynamic compromise
• Idiopathic: 85–90% of cases; likely related to viral infection, which may trigger immune-related process
• Infectious
  • Viral (80–85% of cases): coxsackievirus, echovirus, adenovirus, Epstein-Barr virus, cytomegalovirus, hepatitis viruses, influenza virus, HIV, measles, mumps, varicella, SARS-CoV-2, parvovirus B19
  • Bacterial: Mycobacterium tuberculosis (in endemic countries)
  • Fungal (in immunocompromised populations): Blastomyces dermatitidis, Candida spp., Histoplasma capsulatum
  • Parasites: Echinococcus, Toxoplasma
• Noninfectious causes (15–20% of cases)
  • Acute MI (2 to 4 days after MI), Dressler syndrome (weeks to months after MI); aortic dissection; renal failure, uremia, dialysis-associated; malignancy-associated; radiation therapy; trauma; after cardiac procedures (e.g., catheterization, pacemaker placement, ablation, pericardiotomy)
  • Autoimmune disorders: connective tissue disorders, systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, hypothyroidism, inflammatory bowel disease, Wegener granulomatosis, spondyloarthropathies, sarcoidosis, IgG4-related
  • Suspected vaccination associations: smallpox, influenza, SARS-CoV-2 mRNA vaccine (incidence of ~4.8 per 1 million)
• Medication-induced: dantrolene, doxorubicin, hydralazine, isoniazid, mesalamine, methysergide, penicillin, phenytoin, procainamide, rifampin

Risk Factors

Thoracic surgery, chronic kidney disease, pneumonia, autoimmune diseases, lung or breast cancer especially if treated with radiation therapy