Recurrent pericarditis.

Abstract

The changing prevalence of the aetiological factors in disease is clearly seen in pericarditis. Tuberculosis, pyogenic infection, and rheumatic fever are now relatively rare causes of this condition in Great Britain. Nowadays pericarditis commonly occurs in a relatively benign isolated form, which is often recurrent and of obscure origin (idiopathic pericarditis): virus infection is often implicated but rarely proved. Recurrent pericarditis also occurs as the dominant feature of the postcardiotomy and post-infarction syndromes, and it is common in the so-called collagen diseases. This report concerns observations on a series of patients with idiopathic, postinfarction, and post-cardiotomy pericarditis. It is concluded, as in a previous report on the post-cardiotomy syndrome (Robinson and Brigden, 1963), that there is often good evidence of a hypersensitivity state in these non-pyogenic forms of pericarditis, especially when the disease is recurrent.The Patients This report is based on 20 patients with idiopathic pericarditis, and reference is made to five patients with postinfarction pericarditis and to 16 others with post-cardiotomy syndrome. Patients with pericarditis due to tuberctilosis and those with pericarditis due to known connective tissue disease such as rheumatoid arthritis and lupus erythematosus, or to a metabolic disorder such as uraemia, seen during the same period were excluded. All were admitted to hospital at some time during the illness and all had unequivocal evidence of pericardial inflammation. Their ages ranged from 13 to 70 (paediatric cases were not included). In 'the idiopathic group the average age was 37 and there was a 2: 1 preponderance of males. In the post-cardiotomy group the average age was 42 and there was a preponderance of females (most operations were on patients with rheumatic mitral valve disease). The average age of the post-infarction group was 55 and all were men. All had had several clinical examinations, electrocardiograms, x-ray films, simple hiematological tests, and serial E.S.R.s. Most had had tests for antiheart antibodies with tanned red cells (T.R.C.T.), some had had virus studies, and some had had tests for myocardial enzymes in the serum. Case ReportsThe

Recurrent pericarditis. Relief with colchicine.

“…Once the acute crisis was controlled with prednisone and colchicine, prednisone was progressively decreased until total withdrawal at 1 month. The patient is presently asymptomatic 22 months later and is on only colchicine.…”

Relapsing pericarditis

“…2 Their frequency in clinical series including more than 40 patients [3][4][5][6][7] varies between 8-80% (average 24%), with no distinction between incessant and intermittent types. In our experience, 7 one or more recurrences were present in 44 of 221 consecutive patients with acute idiopathic pericarditis.…”

Colchicine Treatment for Recurrent Pericarditis

“…[2][3][4][5] Recurrent pericarditis is, in most cases, idiopathic. The pathophysiological process may involve the immune system 6,7 : high titers of anti-myocardial antibodies have been found in post-open heart surgery patients with acute pericarditis. The optimal method for preventing recurrences has not been established.…”