Heart & vascular pathology
Inflammatory disease
Noninfective pericarditis
Author: R. Amita, M.D.
Last author update: 1 June 2014
Last staff update: 27 December 2021
Copyright: 2014-2024, PathologyOutlines.com, Inc.
PubMed Search: Noninfective pericarditis
Table of Contents
Definition / general | Terminology | Pathophysiology | Etiology | Clinical features | Diagnosis | Laboratory | Case reports | Treatment | Prognosis | Gross description | Microscopic (histologic) images | Differential diagnosis | Additional referencesCite this page: Amita R. Noninfective pericarditis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/heartnoninfecpericarditis.html. Accessed July 15th, 2024.
Definition / general
- Pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub and serial ECG changes
Terminology
- Idiopathic pericarditis
- Acute pericarditis
- Chronic pericarditis
- Chronic effusive pericarditis and chronic constrictive pericarditis
- Recurrent pericarditis
Pathophysiology
- The acute inflammatory response in pericarditis can produce either serous or purulent fluid or a dense fibrinous material
- Neoplastic, tuberculous, and purulent pericarditis may be associated with large effusions that are hemorrhagic and exudative
- Prolonged pericarditis may result in persistent accumulation of pericardial fluid which may form a thick coating that surrounds the myocardium causing constrictive pericarditis
Etiology
- Idiopathic: No identifiable etiology found after routine testing
- Specific causes:
- Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever
- Myocardial infarction (Dressler syndrome)
- Trauma to the heart, e.g. puncture, resulting in infection or inflammation
- Uremia (uremic pericarditis)
- Malignancy (as a paraneoplastic phenomenon)
- Side effect of medication, e.g. isoniazid, cyclosporine, hydralazine, warfarin, heparin
- Radiation induced
- Aortic dissection
- Tetracyclines
- Postpericardiotomy syndrome: usually after CABG surgery
Clinical features
- Chest pain, usually precordial or retrosternal
- Low grade intermittent fever
- Dyspnea / tachypnea
- Cough and dysphagia
- Malignancy associated pericarditis: fever, night sweats, and weight loss are common
Diagnosis
- Initial evaluation includes a clinical history and physical examination, ECG, echocardiography, chest radiography, lab studies
- 12 lead electrocardiogram shows diffuse, nonspecific, concave, ST segment elevation in all leads except aVR and V1; also PR segment depression is possible in any lead except aVR; sinus tachycardia and low voltage QRS complexes may be seen if subsymptomatic levels of pericardial effusion
- The PR depression is often seen early in the process as the thin atria are affected more easily than the ventricles by the inflammatory process of the pericardium
Laboratory
- Increased urea (BUN) or increased blood creatinine in uremic pericarditis
- Troponin (I, T), CK-MB, myoglobin, and LDH1 (Lactase Dehydrogenase isotype 1) may be normal or elevated
Case reports
- 54 year old man with constrictive pericarditis after renal transplant (J Med Case Rep 2014;8:8)
- 83 year old man with complicated pericarditis (Proceedings of UCLA Healthcare 2011;15)
Treatment
- Aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Pericardiocentesis to treat pericardial effusion / tamponade
- Antibiotics to treat tuberculosis or other bacterial causes
- Steroids are not recommended because they increase the risk of recurrent pericarditis
- Pericardiectomy in rare cases
Prognosis
- Generally, acute pericarditis is benign and self limiting
- Complications include tamponade, constriction, or recurrence
- Nearly 50% will have recurrence
Gross description
- Epicardial surface appears roughened compared to its normal glistening appearance; this is due to strands of pink-tan fibrin
Microscopic (histologic) images
Images hosted on other servers:
No granulomatous inflammation
Differential diagnosis
- Myocardial infarction
Additional references
