Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (8)

Pericarditis
Other Resources UpToDate PubMed

Pericarditis

Contributors: Alanna Peterson MD, Nicholas Genes MD, PhD, Ryan Hoefen MD, PhD, Bruce Lo MD
Other Resources UpToDate PubMed

Synopsis

Emergent Care / Stabilization: Start an intravenous (IV) line and evaluate for signs and symptoms of cardiac tamponade. If present and hemodynamically significant, drainage via pericardiocentesis or pericardial window should be performed as soon as possible.

Etiology / Pathophysiology: Pericarditis is an inflammation of the fibrous tissue sac surrounding the heart. The exact incidence of pericarditis is unknown, although data suggests it represents 5% of emergency department (ED) visits admitted for chest pain.

Pericarditis of an infectious etiology is predominantly viral (90%). The most common of these include coxsackievirus A or B, echovirus, Epstein-Barr virus, HIV, cytomegalovirus, and parvovirus B19. Viral pericarditis may also involve the myocardium, causing myopericarditis. SARS-CoV-2 is associated with both pericarditis and myocarditis with higher mortality than other viral illnesses. Additionally, rare cases of myocarditis following SARS-CoV-2 vaccination have been reported, predominantly in younger males.

The most common bacterial pathogens include Staphylococcus aureus, Streptococcus pneumoniae, and, in developing countries, tuberculosis. Fungi such as Candida spp and parasites such as Toxoplasma gondii also cause pericarditis.

Noninfectious causes include trauma, surgery (especially cardiothoracic surgery such as coronary artery bypass grafting), myocardial infarction, uremia, aortic dissection, myxedema, radiation, rheumatological conditions (including lupus, sarcoidosis, rheumatoid arthritis, and scleroderma), medications (including hydralazine, procainamide, methyldopa, phenytoin, and penicillin), and malignancy (eg, sarcoma, lymphoma, pericardial mesothelioma). Many cases are idiopathic.

Symptoms and Signs: Acute pericarditis typically presents with sharp pleuritic chest pain, exacerbated by the supine position and improved with leaning forward. Fever and myalgias may be present but are not required features. On examination, a scratch-like friction rub (pericardial rub) may be heard, although this is present in less than 33% of cases. To make the diagnosis of pericarditis, the patient must have 2 of 4 criteria: pericardial rub, chest pain, ECG changes, and/or presence of a pericardial effusion. Chest pain has the highest incidence and is seen in 85%-90% of cases.

While not usually life-threatening, acute pericarditis can progress to cardiac tamponade or constrictive pericarditis in some complicated cases. Consider constrictive pericarditis in cases of unexplained heart failure. Tricuspid regurgitation is common in these patients and is associated with increased mortality. Other findings in constrictive pericarditis can include Kussmaul sign (a paradoxical increase in jugular venous pressure on inspiration), jugular venous distention, peripheral edema, hepatomegaly, and pericardial knock.

Predisposing Medical History and Risk Factors: As described above, viral infections often precede pericarditis, and patients may report systemic signs and symptoms of infection. Pericarditis should also be considered in any patient with recent cardiothoracic surgery or underlying rheumatologic disease. Recurrent pericarditis is seen in 15%-30% of patients.

Codes

ICD10CM:
I31.9 – Disease of pericardium, unspecified

SNOMEDCT:
3238004 – Pericarditis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Subscription Required

References

Subscription Required

Last Reviewed:08/29/2022
Last Updated:02/12/2024
Copyright © 2024 VisualDx®. All rights reserved.
Pericarditis
A medical illustration showing key findings of Pericarditis : Fever, Cardiomegaly, Pericardial effusion, Pericardial friction rub, Pleuritic chest pain, Dyspnea, Diffuse ST elevation, PR depression
Imaging Studies image of Pericarditis - imageId=6789416. Click to open in gallery.  caption: '<span>Frontal view from chest xray demonstrating cardiomegaly in a patient with a history of pericardits.</span>'
Frontal view from chest xray demonstrating cardiomegaly in a patient with a history of pericardits.
Copyright © 2024 VisualDx®. All rights reserved.