7 A Toolkit for Health Care Professionals Recurrent Pericarditis Acute pericarditis is caused by an inflammatory process that occurs commonly and can occur in isolation or as a consequence of an underlying autoimmune disorder. It occurs more often in males ages 20-50 years.8 Most causes of acute pericarditis are idiopathic and presumed to occur post-viral.9 In developing countries with a high prevalence, tuberculosis (TB) with or without HIV co-infection is a common cause of pericarditis. In developed countries with a low prevalence of TB, conditions causing pericarditis are systemic inflammation, cancers such as lung, breast, lymphomas and leukemia, chest irradiation, post-cardiac surgery injury syndromes, including pericarditis post-myocardial infarction, percutaneous coronary intervention and electrophysiology procedures or post-pericardiectomy.9,10 The diagnosis is made in the presence of two or more of the following: 1. Precordial chest pain that worsens with inspiration and is relieved by sitting forward 2. A pericardial friction rub on auscultation 3. Diffuse ST elevation across the precordial leads or PR-depression with reciprocal changes in aVR 4. A new or worsening pericardial effusion Diagnostic workup includes a review of past medical history, physical examination with a focus on heart auscultation, chest X-ray, electrocardiogram, echocardiography and laboratory tests for markers of inflammation [C-Reactive Protein (CRP)], troponin and thyroid levels.11 Further investigation is not recommended since most often the cause is viral or idiopathic. For patients experiencing high fever [>38º C (>100.4º F)], subacute course, development of a large pericardial effusion, cardiac tamponade or no response to non-steroidal anti-inflammatory drugs >7 days warrant more extensive diagnostic testing.12 Recurrent pericarditis may occur in approximately 20%-30% of patients as a complication of acute pericarditis after a symptom-free interval of 4 to 6 weeks or longer. Diagnostic testing is similar to that done in the acute phase. It occurs more commonly in those who were not treated with colchicine.13 The 2015 European Society of Cardiology (ESC) Guidelines recommend diagnostic testing of CRP, computed tomography (CT) and/or cardiovascular magnetic resonance (CMR) to support diagnosis in atypical cases to investigate pericardial inflammation evidenced by edema and contrast enhancement of the pericardium.1 Inflammation of the pericardium. BruceBlaus, CC BY-SA 4.0 (https://creativecommons.org/licenses/ by-sa/4.0), via Wikimedia Commons The ECG in acute pericarditis. Dr. Ihab Suliman, CC BY-SA 4.0 (https://creativecommons.org/ licenses/by-sa/4.0), via Wikimedia Commons
RkJQdWJsaXNoZXIy MjI2NjI=