Evaluation and management of pericarditis

Abstract

Pericarditis may be caused by infectious or noninfectious noxa. Most cases are labeled as 'idiopathic' because the traditional diagnostic approach often fails to identify the etiology. Most important causes are presumed to be viruses in countries with a low prevalence of tuberculosis and tuberculosis in developing countries. Noninfectious pericarditis mainly includes autoimmune systemic diseases, post-pericardiotomy syndromes and neoplastic pericardial disease. Treatment should be targeted to the cause, but remains empirical with NSAIDs and the possible adjunct of colchicine in idiopathic cases. Corticosteroids use should be limited to patients with NSAID contraindications/intolerance or failure, and rarely for specific conditions (i.e., pregnancy and systemic autoimmune diseases). Recurrences are the most common complication, but the overall prognosis is related to the etiology, usually benign in idiopathic pericarditis.

Contemporary management of pericardial diseases

“…criteria (pleuritic chest pain, pericardial rubs, widespread ST-segment elevation, pericardial effusion), whereas the identification of the cause may be more complex [1,2,5]. In developed countries, the clinicians should rule out neoplastic, tuberculous, and purulent pericarditis, as well as pericarditis related to a systemic disease [1, 11,12]. Tuberculosis is the most important cause of pericardial diseases in the world and developing countries, where the disease is endemic [9].…”

Acute purulent pericarditis caused by Clostridium septicum

“…Jestliže se pacient neléčí, je onemocnění zpravidla letální [1]. Purulentní perikarditida naštěstí představuje pouze 1 % všech případů tohoto onemocnění; incidence je 0,27 na 100 000 obyvatel [3]. Zatímco v západních zemích jsou hlavními patogeny stafylokoky, streptokoky nebo pneumokoky, v rozvojových zemích se častěji vyskytuje tuberkulózní perikarditida [1][2][3].…”

“…Vzhledem k možnosti hematogenního šíření je nutno určit zdroj infekce a odpovídajícím způsobem ho zaléčit. Přes účinnost antibiotické léčby je mortalita enormně vysoká [1][2][3].…”

Modern Advances in Cardiovascular Imaging: Cardiac Computed Tomography and Cardiovascular Mri in Pericardial Disease

“…Most clinical situations related to PEff or tamponade do not require advanced imaging for diagnosis, as TTE is often more than adequate for diagnosis and can often be utilized for echo-guided pericardial drainage if necessary (Box 4) [36,37]. There is no definable role for cardiac CTA or CMR in the assessment of acute pericardial tamponade, although advanced imaging (e.g., transesophageal echocardiography or CTA) could be useful when the effusion is believed to be secondary to aortic dissection or requires additional assessment, such as concern for right atrial tamponade in post-cardiac surgery patients.…”