Pericarditis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Pericarditis symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position.
The classic physical finding is a pericardial friction rub. A low-grade fever may be present.
Diagnostic signs include widespread electrocardiographic ST elevation or PR depression and a new or worsening pericardial effusion on echocardiography; blood tests generally suggest systemic inflammation.
Treatment is directed at any underlying systemic disorder. Idiopathic or viral pericarditis responds to nonsteroidal anti-inflammatory drugs and colchicine.
Complications include chronic recurrent pericarditis, cardiac tamponade, and constrictive pericarditis.

ECG in a patient with acute pericarditis, showing diffuse ST-segment elevation in the precordial leads. There is also PR-segment depression in leads V2-V6 (arrows)

Rathore S, Dodds PA. BMJ Case Reports 2009; doi:10.1136/bcr.2006.097071

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Constrictive pericarditis identified at autopsy; the right section is scar tissue cut from the very front of the heart
ECG in a patient with acute pericarditis, showing diffuse ST-segment elevation in the precordial leads. There is also PR-segment depression in leads V2-V6 (arrows)
Chest CT showing a double layer of pericardial calcification in a 56-year-old male patient with idiopathic calcific constrictive pericarditis
Chest CT in a baby with purulent pericarditis showing a pericardial collection with compression of the left (LV) and right (RV) ventricles
Echocardiogram in a baby with purulent pericarditis, showing a pericardial collection. LV = left ventricle, RV = right ventricle
Open surgery in a baby with purulent pericarditis; the abscess is indicated by the arrow
Pericardectomy in a 56-year-old male patient with idiopathic calcific constrictive pericarditis. The pericardium is thickened and calcified

Citations

Key Articles

Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36:2921-64.[Abstract][Full Text]
Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of acute and recurrent pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jan 7;75(1):76-92.[Abstract][Full Text]
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-e454.[Abstract][Full Text]

Referenced Articles

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