Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-50: Acute Inflammatory Pericarditis + Key Features Download Section PDF Listen +++ ++ Causes Infections Autoimmune diseases Uremia Neoplasms Radiation Drug toxicity Hemopericardium Postcardiac surgery Contiguous inflammatory processes of the heart or lung (eg, myocardial infarction [MI], Dressler syndrome, idiopathic) Viral infections are the most common cause; acute pericarditis often follows upper respiratory tract infection Males, usually younger than age 50, are most commonly affected + Clinical Findings Download Section PDF Listen +++ ++ Often associated with pleuritic chest pain, relieved by sitting, that radiates to the neck, shoulders, back, or epigastrium Dyspnea and fever Pericardial friction rub with or without evidence of pericardial effusion or constriction Pericardial involvement Tuberculous pericarditis: subacute; symptoms may be present for days to months Bacterial pericarditis: rare; patients appear toxic and are often critically ill Uremic pericarditis: symptoms may or may not be present; fever is absent Neoplastic pericarditis: often painless, hemodynamic compromise Dressler syndrome (post-MI pericarditis) Occurs within days to 3 months post-MI Usually self-limited + Diagnosis Download Section PDF Listen +++ ++ Usually clinical Leukocytosis ECG Generalized ST-T wave changes, characteristic progression beginning with diffuse ST elevations, followed by a return to baseline, then T wave inversions PR depression indicates atrial injury Chest radiograph Frequently normal Cardiac enlargement if pericardial effusion Signs of related pulmonary disease Echocardiogram Often normal in inflammatory pericarditis Otherwise, can demonstrate pericardial effusion, tamponade Erythrocyte sedimentation rate or inflammatory C-reactive protein usually elevated The American Society of Echocardiography proposes adding an elevated C-reactive protein and late gadolinium enhancement of the pericardium to confirmatory diagnostic criteria Screening chest CT or MRI is often recommended to ensure there is no extracardiac diseases contiguous to the pericardium PET scanning can also be used to help define pericardial inflammation Rising titers in paired sera may confirm viral infection but are rarely done Cardiac enzymes slightly elevated if there is an epicardial myocarditis component Cytology of pericardial effusion or pericardial biopsy may be helpful Usually data from a diagnostic pericardial tap is unhelpful in diagnosis MRI and CT scan can visualize adjacent tumor when present + Treatment Download Section PDF Listen +++ ++ Restrict activity until symptom resolution; for athletes, exercise should be restricted until symptoms resolve and all laboratory tests are normal (generally 3 months) The 2015 European Society of Cardiology guidelines Aspirin, 750–1000 mg every 8 hours for 1–2 weeks, tapering the dose by 250–500 mg every 1–2 weeks or Ibuprofen, 600 mg every 8 hours for 1–2 weeks, tapering the dose by 200–400 mg every 1–2 weeks Gastroprotection should be included Colchicine Initial treatment of the acute episode helps prevent recurrences Should be added to the NSAID at 0.5–0.6 mg once daily for patients < 70 kg or twice daily for patients > 70 kg and continued for 3 months In all refractory and recurrent cases, colchicine should also be the initial therapy and used for at least 6 months The C-reactive protein is used to assess the effectiveness of therapy and, once normalized, tapering is initiated Tapering of colchicine is not mandatory Indomethacin, 25–50 mg every 8 hours, can be considered in recurrent pericarditis in place of ibuprofen Aspirin and colchicine should be used instead of NSAIDs in postmyocardial infarction pericarditis (Dressler syndrome) Aspirin: 750–1000 mg three times daily for 1–2 weeks plus Colchicine: 3 months Systemic corticosteroids (eg, prednisone 0.25–0.5 mg/kg/day orally, tapering over 4–6 weeks) can be used in patients with severe symptoms, in refractory cases, or in patients with immune-mediated etiologies, but such therapy may entail a higher risk of recurrence and colchicine is recommended in addition for 3 months, to help prevent recurrences Pericardial stripping may be considered if colchicine plus more significant immunosuppression fails