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(New page: {{SI}} {{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} {{Editor Join}} ==History and Symptoms== A diagnosis of pericarditis can be made depending on its etiology and speed of onset. ...)
 
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==Overview==
[[Patients]] with [[pericarditis]] commonly present with [[chest pain]] that changes with position, [[cough]], [[fever]], [[breathlessness]], and [[fatigue]] are the other common [[symptoms]]. Less common [[symptoms]] include [[palpitations]], [[hiccup]], [[odynophagia]], [[Syncope|faint]], [[dizziness]], and [[abdominal pain]] which is seen mostly in [[children]].


==History and Symptoms==
==Common Symptoms==
A diagnosis of pericarditis can be made depending on its etiology and speed of onset. For example, both uremic and tuberculosis induced pericarditis develop more slowly and can be undetectable until presenting "as a fever of unknown origin." On the other hand, both bacterial and viral pericarditis develop rapidly and can present as increasing "pain over several hours."
Common [[symptoms]] of [[pericarditis]] include:<ref name="KleinAbbara2013">{{cite journal|last1=Klein|first1=Allan L.|last2=Abbara|first2=Suhny|last3=Agler|first3=Deborah A.|last4=Appleton|first4=Christopher P.|last5=Asher|first5=Craig R.|last6=Hoit|first6=Brian|last7=Hung|first7=Judy|last8=Garcia|first8=Mario J.|last9=Kronzon|first9=Itzhak|last10=Oh|first10=Jae K.|last11=Rodriguez|first11=E. Rene|last12=Schaff|first12=Hartzell V.|last13=Schoenhagen|first13=Paul|last14=Tan|first14=Carmela D.|last15=White|first15=Richard D.|title=American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease|journal=Journal of the American Society of Echocardiography|volume=26|issue=9|year=2013|pages=965–1012.e15|issn=08947317|doi=10.1016/j.echo.2013.06.023}}</ref><ref name="Imazio2012">{{cite journal|last1=Imazio|first1=Massimo|title=Contemporary management of pericardial diseases|journal=Current Opinion in Cardiology|volume=27|issue=3|year=2012|pages=308–317|issn=0268-4705|doi=10.1097/HCO.0b013e3283524fbe}}</ref><ref name="ImazioGaita2015">{{cite journal|last1=Imazio|first1=Massimo|last2=Gaita|first2=Fiorenzo|title=Diagnosis and treatment of pericarditis|journal=Heart|volume=101|issue=14|year=2015|pages=1159–1168|issn=1355-6037|doi=10.1136/heartjnl-2014-306362}}</ref><ref name="Imazio2011">{{cite journal|last1=Imazio|first1=M.|title=Pericardial involvement in systemic inflammatory diseases|journal=Heart|volume=97|issue=22|year=2011|pages=1882–1892|issn=1355-6037|doi=10.1136/heartjnl-2011-300054}}</ref><ref name="ImazioBrucato2011">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Maestroni|first3=Silvia|last4=Cumetti|first4=Davide|last5=Belli|first5=Riccardo|last6=Trinchero|first6=Rita|last7=Adler|first7=Yehuda|title=Risk of Constrictive Pericarditis After Acute Pericarditis|journal=Circulation|volume=124|issue=11|year=2011|pages=1270–1275|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.111.018580}}</ref>


===Symptoms:===
*[[Chest pain]] is the most common [[symptom]]. It often radiates to the [[back]] and is relieved by sitting up and leaning forward and is worsened by lying down. [[Causes]] of [[pain]] include [[inflammation]] of the [[pericardium]], [[phrenic nerves]], and the nearby [[pleura]]. The [[pain]] is often initially sharp in [[nature]], but it can be described as sticking, dull, [[aching]], or [[pressure]]-like. Deep [[inspiration]] and [[cough]] can increase the [[pain]] so that the [[patient]] may sit upright for relief.
# [[Chest Pain]]: however, pain is often absent (depending on the type of pericarditis e.g. rheumatoid pericarditis).  It is the most common symptom.
*[[Cough]] (either [[Dry cough|dry]] or [[Productive cough|productive]])
#* Some causes of pain include: inflammation of the pericardium, phrenic nerves, and nearby pleura.
*[[Fever]]
#* Quality of pain: sharp, "sticking", dull, aching, or pressure-like. It can be rated anywhere from 1-10.  In the beginning stages, the pain usually starts out as sharp.  "Inspiration and cough" can increase the pain so patients usually "sit upright for relief."
*[[Fatigue]]
# Nonproductive [[cough]] that elicites pleuritic pain
*[[Anxiety]]
# Productive [[cough]], which usually occurs in the presence of other illness(es)
*[[Breathlessness]]
# [[Hiccup]] (rarely)
# [[Odynophagia]] with or without [[Dysphagia]]
# [[Faintness]] and [[Dizziness]] (uncommon unless [[cardiac tamponade]] is present]]
# [[Chest wall]] [[palpitations]]: causing local tenderness and may be indicative of [[costochondritis]], [[Tietze syndrome]], or [[rib fractures]] (in cases of traumatic pericarditis)


==Less Common Symptoms==
Less [[symptoms]] of [[pericarditis]] include:<ref name="KleinAbbara2013" /><ref>{{Cite journal
| author = [[Niraj S. Doctor]], [[Ankit B. Shah]], [[Neil Coplan]] & [[Itzhak Kronzon]]
| title = Acute Pericarditis
| journal = [[Progress in cardiovascular diseases]]
| volume = 59
| issue = 4
| pages = 349–359
| year = 2017
| month = January
| doi = 10.1016/j.pcad.2016.12.001
| pmid = 27956197
}}</ref><ref>{{Cite journal
| author = [[J. Soler-Soler]], [[G. Permanyer-Miralda]] & [[J. Sagrista-Sauleda]]
| title = A systematic diagnostic approach to primary acute pericardial disease. The Barcelona experience
| journal = [[Cardiology clinics]]
| volume = 8
| issue = 4
| pages = 609–620
| year = 1990
| month = November
| pmid = 2249215
}}</ref>
*[[Pain]] along the [[trapezius]] ridge(s), when [[Presenting symptom|present]] is very characteristic of [[pericarditis]]. The [[pain]] of [[myocardial infarction]] tends to involve the [[anterior]] [[precordium]] with [[radiation]] to the left [[arm]].
*[[Palpitation]]s
*[[Hiccup]] ([[Rare|rarely]])
*[[Odynophagia]] with or without [[dysphagia]]
*[[Faintness]] and [[dizziness]] (uncommon unless [[cardiac tamponade]] is present)
*[[Abdominal pain]] (particularly in [[children]])


==See Also==
==Rapidity of Symptom Onset==
 
The rapidity of [[symptom]] onset may provide insight into the underlying [[etiology]] of [[pericarditis]]. For example, [[pericarditis]] associated with both [[uremia]] and [[tuberculosis]] develops more slowly and can be undetectable until it presents as a [[fever of unknown origin]]. On the other hand, both [[bacterial]] and [[viral]] pericarditis develop rapidly and can present as rapidly increasing [[pain]] over several hours.<ref name="Comty1971">{{cite journal|last1=Comty|first1=Christina M.|title=Pericarditis in Chronic Uremia and Its Sequels|journal=Annals of Internal Medicine|volume=75|issue=2|year=1971|pages=173|issn=0003-4819|doi=10.7326/0003-4819-75-2-173}}</ref><ref name="ImazioTrinchero2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Trinchero|first2=Rita|title=Triage and management of acute pericarditis|journal=International Journal of Cardiology|volume=118|issue=3|year=2007|pages=286–294|issn=01675273|doi=10.1016/j.ijcard.2006.07.100}}</ref><ref name="MayosiBurgess2005">{{cite journal|last1=Mayosi|first1=Bongani M.|last2=Burgess|first2=Lesley J.|last3=Doubell|first3=Anton F.|title=Tuberculous Pericarditis|journal=Circulation|volume=112|issue=23|year=2005|pages=3608–3616|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.543066}}</ref>
* [[Hemopericardium]]
* [[Pneumopericardium]]
* [[Chylopericardium]]
* [[Pericardial effusion]]
* [[Congenital absence of the pericardium]]
* [[Pericardial window]]
* [[Pericardial sac]]
* [[Pericardial friction rub]]
* [[Pericardiectomy]]
* [[Pericardiocentesis]]
* [[Pericardium]]
 
==Source==
 
* [http://www.ngc.gov/summary/summary.aspx?doc_id=4960&nbr=003524&string=Cardiac+AND+Tamponade National Guideline Clearinghouse]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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{{WikiDoc Sources}}


== Acknowledgements ==
[[Category:Medicine]]
The content on this page was first contributed by [[C. Michael Gibson, M.S., M.D.]]
 
==Additional Resources==
{{refbegin|2}}
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* Applegate RJ, Johnston WE, Vinten-Johansen J, Klopfenstein HS, Little WC. Restraining effect of intact pericardium during acute volume leading. Am J Physiol. 1992;262:H1725–H1733.
* Artom G, Koren-Morag N, Spodick DH, Brucato A, Guindo J, Bayesde-Luna A, Brambilla G, Finkelstein Y, Granel B, Bayes-Genis A, Schwammenthal E, Adler Y. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multicentre all-case analysis. Eur Heart J. 2005;26:723–727.
* Arunasalam S, Siegel RJ. Rapid resolution of symptomatic acute pericarditis with ketorolac tromethamine: a parenteral nonsteroidal antiinflammatory agent. Am Heart J. 1993;125(pt 1):1455–1458.
* Bonnefoy E, Gordon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. 2000;21:832–836.
* Correale E, Maggioni AP, Romano S, Ricciardiello V, Battista R, Salvarola G, Santoro E, Tognoni G, on behalf of the Gruppo Italiano perlo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI). Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Am J Cardiol. 1993;71:1377–1381.
* Fowler NO. Tuberculous pericarditis. JAMA. 1991;266:99 –103.
* Freeman GL, LeWinter MM. Determinants of the intrapericardial pressure in dogs. J Appl Physiol. 1986;60:758 –764.
* Freeman GL, LeWinter MM. Pericardial adaptations during chronic cardiac dilation in dogs. Circ Res. 1984;54:294 –300.
* Freeman GL, Little WC. Comparison of in situ and in vitro studies of pericardial pressure-volume relation in the dog. Am J Physiol. 1986;251: H421–H427.
* Gunukula SR, Spodick DH. Pericardial disease in renal patients. Semin Nephrol. 2001;21:52–56.
* Hoit BD, Gabel M, Fowler NO. Cardiac tamponade in left ventricular dysfunction. Circulation. 1990;82:1370–1376.
* Imazio M, Bobbio M, Cecchi E, Demarie D, Demichellis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghiso A, Belli R, Trinchero R. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) Trial. Circulation. 2005;112:2012–2016.
* Imazio M, Demichellis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. 2003;42:2144–2148.
* Imazio M, Demichellis B, Parrini I, Gluggia M, Cecchi E, Gaschino G, Demarie D, Ghislo A, Trinchero R. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. 2004;43:1042–1046.
* Jerjes-Sanchez C, Ramirez-Rivera A, Ibarra-Perez C. The Dressler syndrome after pulmonary embolism. Am J Cardiol. 1996;78:343–345.
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* Klopfenstein HS, Schuchard GH, Wann LS, Palmer TE, Hartz AJ, Gross CM, Singh S, Brooks HL. The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: an experimental echocardiographic study. Circulation. 1985;71: 829–833.
* Knopf WD, Talley JD, Murphy DA. An echo-dense mass in the pericardial space as a sign of left ventricular free wall rupture during acute myocardial infarction. Am J Cardiol. 1987;59:1202.
* Lange RA, Hillis D. Acute pericarditis. N Engl J Med. 2004;351: 2195–2202.
* LeWinter MM, Kabbani S. Pericardial diseases. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease. 7th ed. Philadelphia, Pa: Elsevier Saunders; 2005:1757–1780.
* Maisch B, Ristic D, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone. Eur Heart J. 2002;23: 1503–1508.
* Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH, for the Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases: executive summary. Eur Heart J. 2004;25:587– 610.
* Maisch B. Recurrent pericarditis: mysterious or not so mysterious? Eur Heart J. 2005;26:631– 633.
* Mandell BF. Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum. 1987;17:126 –141.
* Miyazaki T, Pride HP, Zipes DP. Prostaglandins in the pericardial fluid modulate neural regulation of cardiac electrophysiological properties. Circ Res. 1990;66:163–175.
* Park JH, Choo SJ, Park SW. Acute pericarditis caused by acrylic bone cement after percutaneous vertebroplasty. Circulation. 2005; 111:e98.
* Permanyer-Miralda G, Sagrista-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985;56:623– 630.
* Permanyer-Miralda G. Acute pericardial disease: approach to the aetiologic diagnosis. Heart. 2004;90:252–254.
* Reddy PS, Curtiss EI, O’Toole JD, Shaver JA. Cardiac tamponade: hemodynamic observations in man. Circulation. 1978;58:265–272.
* Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol. 1990;66:1487–1491.
* Shabetai R, Fowler NO, Guntheroth WG. The hemodynamics of cardiac tamponade and constrictive pericarditis. Am J Cardiol. 1970;26: 480–489.
* Shabetai R. Pericardial effusion: haemodynamic spectrum. Heart. 2004; 90:255–256.
* Shabetai R. Recurrent pericarditis: recent advances and remaining questions. Circulation. 2005;112:1921–1923.
* Singh S, Wann S, Schuchard GH, Klopfenstein HS, Leimgruber PP, Keelan MH, Brooks HL. Right ventricular and right atrial collapse in patients with cardiac tamponade: a combined echocardiographic and hemodynamic study. Circulation. 1984;70:966–971.
* Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349: 684–690.
* Spodick DH. Acute pericarditis: current concepts and practice. JAMA. 2003;289:1150 –1153.
* Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis / myopericarditis and pericardial effusion. Eur Heart J. 2002;23: 1481–1482.
* Spodick DH. Macrophysiology, microphysiology, and anatomy of the pericardium: a synopsis. Am Heart J. 1992;124:1046 –1051.
* Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004;363: 717–727.
* Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, Seward JB. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979–1998. Chest. 1999;116:322–331.
* Tsang TS, Oh JK, Seward JB, Tajik AJ. Diagnostic value of echocardiography in cardiac tamponade. Herz. 2000;25:734–740.
* Zayas R, Anguita M, Torres F, Gimenez D, Bergillos F, Ruiz M, Ciudad M, Gallardo A, Valles F. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. 1995;75:378 –382.
{{refend}}
 
== Suggested Links and Web Resources ==
* [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
* http://en.wikipedia.org/wiki/Pericarditis
* [http://www.SeeMyHeart.org SeeMyHeart] - Patient Information on Echocardiograms (Heart Ultrasounds)
* [http://www.asecho.org American Society] of Echocardiography
* [http://www.ptca.org/imaging/stress_test.html Stress Test with Echocardiography] from Angioplasty.Org
* [http://heartcenter.seattlechildrens.org/what_to_expect/echocardiogram.asp Echocardiography information] from Children's Hospital Heart Center, Seattle.
* [http://know-heart-diseases.com Coronary heart disease] And echocardiography
* [http://www.echocardiology.org Echocardiography Resources] Simple echocardiography tutorials
* [http://www.manbit.com/ERS/ERSindex.asp Atlas of Echocardiography] Echocardiography Database
* [http://www2.umdnj.edu/~shindler/index.html E-chocardiography] Internet Journal of Cardiac Ultrasound
* [http://www.echobasics.de Echobasics] Basic introduction to echocardiography - German/Spanish English planned for 2007
* [http://www.mitral.com/echocardiography.shtml Echocardiography] Basic information about echocardiography - HealthwoRx
 
== For Patients ==
 
* [http://www.mssm.edu/cvi/pericarditis.shtml#q1 Pericarditis]
 
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Latest revision as of 23:39, 29 July 2020

Pericarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

HIV
Post MI
Dressler's syndrome
Post-pericardiotomy
Radiation
Tuberculosis
Uremia
Malignancy

Differentiating Pericarditis from other Diseases

Epidemiology and Demographics

Screening

Natural History, Complications and Prognosis

Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Homa Najafi, M.D.[3]

Overview

Patients with pericarditis commonly present with chest pain that changes with position, cough, fever, breathlessness, and fatigue are the other common symptoms. Less common symptoms include palpitations, hiccup, odynophagia, faint, dizziness, and abdominal pain which is seen mostly in children.

Common Symptoms

Common symptoms of pericarditis include:[1][2][3][4][5]

Less Common Symptoms

Less symptoms of pericarditis include:[1][6][7]

Rapidity of Symptom Onset

The rapidity of symptom onset may provide insight into the underlying etiology of pericarditis. For example, pericarditis associated with both uremia and tuberculosis develops more slowly and can be undetectable until it presents as a fever of unknown origin. On the other hand, both bacterial and viral pericarditis develop rapidly and can present as rapidly increasing pain over several hours.[8][9][10]

References

  1. ↑ 1.0 1.1 Klein, Allan L.; Abbara, Suhny; Agler, Deborah A.; Appleton, Christopher P.; Asher, Craig R.; Hoit, Brian; Hung, Judy; Garcia, Mario J.; Kronzon, Itzhak; Oh, Jae K.; Rodriguez, E. Rene; Schaff, Hartzell V.; Schoenhagen, Paul; Tan, Carmela D.; White, Richard D. (2013). "American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease". Journal of the American Society of Echocardiography. 26 (9): 965–1012.e15. doi:10.1016/j.echo.2013.06.023. ISSN 0894-7317.
  2. ↑ Imazio, Massimo (2012). "Contemporary management of pericardial diseases". Current Opinion in Cardiology. 27 (3): 308–317. doi:10.1097/HCO.0b013e3283524fbe. ISSN 0268-4705.
  3. ↑ Imazio, Massimo; Gaita, Fiorenzo (2015). "Diagnosis and treatment of pericarditis". Heart. 101 (14): 1159–1168. doi:10.1136/heartjnl-2014-306362. ISSN 1355-6037.
  4. ↑ Imazio, M. (2011). "Pericardial involvement in systemic inflammatory diseases". Heart. 97 (22): 1882–1892. doi:10.1136/heartjnl-2011-300054. ISSN 1355-6037.
  5. ↑ Imazio, Massimo; Brucato, Antonio; Maestroni, Silvia; Cumetti, Davide; Belli, Riccardo; Trinchero, Rita; Adler, Yehuda (2011). "Risk of Constrictive Pericarditis After Acute Pericarditis". Circulation. 124 (11): 1270–1275. doi:10.1161/CIRCULATIONAHA.111.018580. ISSN 0009-7322.
  6. ↑ Niraj S. Doctor, Ankit B. Shah, Neil Coplan & Itzhak Kronzon (2017). "Acute Pericarditis". Progress in cardiovascular diseases. 59 (4): 349–359. doi:10.1016/j.pcad.2016.12.001. PMID 27956197. Unknown parameter |month= ignored (help)
  7. ↑ J. Soler-Soler, G. Permanyer-Miralda & J. Sagrista-Sauleda (1990). "A systematic diagnostic approach to primary acute pericardial disease. The Barcelona experience". Cardiology clinics. 8 (4): 609–620. PMID 2249215. Unknown parameter |month= ignored (help)
  8. ↑ Comty, Christina M. (1971). "Pericarditis in Chronic Uremia and Its Sequels". Annals of Internal Medicine. 75 (2): 173. doi:10.7326/0003-4819-75-2-173. ISSN 0003-4819.
  9. ↑ Imazio, Massimo; Trinchero, Rita (2007). "Triage and management of acute pericarditis". International Journal of Cardiology. 118 (3): 286–294. doi:10.1016/j.ijcard.2006.07.100. ISSN 0167-5273.
  10. ↑ Mayosi, Bongani M.; Burgess, Lesley J.; Doubell, Anton F. (2005). "Tuberculous Pericarditis". Circulation. 112 (23): 3608–3616. doi:10.1161/CIRCULATIONAHA.105.543066. ISSN 0009-7322.

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