10.Pericarditis

Pericarditis Overview

  • Definition: Polyetiological inflammation of the pericardium (infectious/non-infectious) leading to fibrotic changes or fluid accumulation.

  • Symptoms: Often asymptomatic, may be a complication of underlying disease.

Classification of Pericarditis

Etiological Classification

  1. Idiopathic Pericarditis

  2. Infectious Pericarditis

    • Viral: Coxsackie viruses, Epstein Barr, etc.

    • Bacterial: Streptococcus pneumoniae, Mycobacterium tuberculosis, etc.

    • Fungal: Candida, Histoplasma.

    • Parasitic: Entamoeba histolytica, Echinococcus.

  3. Non-infectious Pericarditis

    • Systemic autoimmune diseases (e.g., SLE, rheumatoid arthritis).

    • Metabolic disorders (e.g., uremia, Addison's disease).

    • Traumatic and neoplastic causes.

Clinical Classification

  • Acute Pericarditis: Duration < 6 weeks.

    • Types: Fibrinous, Exudative (with/without tamponade).

  • Subacute Pericarditis: 6 weeks to 6 months.

  • Chronic Pericarditis: > 6 months.

    • Types: Exudative, Adhesive, Constrictive.

Pathogenesis

  • Process: Begins with inciting insult leading to vasodilation, transudation of fluid, increased vascular permeability, and leukocyte exudation.

  • Resolution: Typically a self-limiting inflammation.

Clinical Features

Dry Pericarditis

  • Characteristics: Limited inflammation, absence of effusion.

  • Symptoms: Chest pain, pleuritic in nature, worsens in supine position.

Exudative Pericarditis

  • Characteristics: Widespread inflammation, accumulation of fluid.

  • Symptoms: Fever, chills, heaviness in cardiac region, may include dysphagia and cough.

Diagnosis

Inspections and Examination

  • Auscultation: Friction sounds in dry pericarditis; absent in effusion.

  • Laboratory Tests: Non-specific signs, leukocytosis, ESR elevation.

  • ECG Findings: ST segment elevation; low voltage in tamponade.

  • Echocardiography: Detects fluid accumulation and cardiac structure changes.

Treatment

  • NSAIDs: First line for acute pericarditis.

  • Glucocorticoids: Reserved for severe cases and certain underlying conditions.

  • Pericardiocentesis: For effusion; may need repeat interventions.

  • Surgical Intervention: Pericardectomy for constrictive pericarditis.

Prognosis

  • Generally favorable for dry pericarditis; some risks of progression to effusive or constrictive forms.

  • Recovery time varies; long-term outcomes depend on the type and treatment effectiveness.