5 A Toolkit for Health Care Professionals Recurrent Pericarditis Acute pericarditis is an inflammatory pericardial syndrome with or without pericardial effusion, typically presenting within four weeks of symptom onset. It occurs more often in males aged 20–50 years,8 and most cases are idiopathic and presumed to be 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 with a clinical presentation including chest pain or infarct-like symptoms, arrhythmias, heart failure or aborted sudden cardiac death. Diagnostic criteria have evolved with the publication of the 2025 European Society of Cardiology (ESC) Guidelines, placing more emphasis on the clinical presence of classic chest pain or equivalent. 1. Clinical presentation: pleuritic/infarct-like chest pain (present in 85-90% of cases) or equivalent 2. Plus ≥1 additional finding (0 = unlikely/rejected, 1 = possible, and 2+ = definite diagnosis): a. Pericardial friction rub b. Electrocardiogram changes consisting of diffuse STsegment elevation and/or PR-segment depression c. Inflammatory biomarkers elevation (such as C-reactive protein [CRP] or sedimentation rate) d. Cardiac imaging (especially echocardiography evidence) of new or worsening pericardial effusion e. Cardiac imaging evidence of pericardial inflammation 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 nonsteroidal 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. Diagnostic testing is similar to that done in the acute phase. It occurs more commonly in those who were not treated with colchicine.13 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
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