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Pericarditis

Updated : February 8, 2024





Background

The most prevalent pathological disease involving the pericardium is pericarditis, which refers to inflammation of the pericardial sac. Other pericardial disorders, such as cardiac tamponade, pericardial effusion, effusive-constrictive pericarditis, and constrictive pericarditis, may be linked with pericarditis.

Pericardial inflammation is frequently associated with increased fluid buildup inside the pericardial sac, resulting in a pericardial effusion that can be hemorrhagic, purulent, or serous based on the cause.

This fluid buildup may become hemodynamically substantial, especially if the pericardial effusion is significant or the pace of accumulation is rapid since the fluid can externally compress the heart chambers, restricting diastolic filling and creating the cardiac tamponade syndrome. This can emerge as obstructive shock and is classified as a medical emergency that needs immediate attention.

Epidemiology

Pericarditis is a leading cause of chest pain and one of the most prevalent type of pericardial disease. It is also linked with uremic patients, malignant illness, and trauma. It is more prevalent in men.

Anatomy

Pathophysiology

The pericardium performs several functions. It serves as a thoracic cavity anchor for the heart, creates a barrier against extrinsic infection, and improves dynamic contact within the cardiac chambers.

Despite considerations about higher cardiac mobility and displacement inside the chest cavity, investigations have demonstrated that individuals had similar left ventricular ejection fraction and life expectancy as the general population.

Because of the extensive innervation of the parietal layer, any inflammatory condition mediated by an autoimmune, infectious, or traumatic damage can result in significant retrosternal chest discomfort, as observed in acute pericarditis.

Etiology

Viruses are the most prevalent infective agents, including echovirus, coxsackieviruses A & B, adenoviruses, HIV, parvovirus B19, influenza, and several herpes viruses, like CMV and EBV. Bacterial causes of pericarditis are uncommon in developed countries; nonetheless, TB infection is still widespread in underdeveloped nations and is considered the predominant cause of pericarditis in endemic areas.

Other bacteria that cause pericarditis include Meningococcus, Coxiella burnetii, Pneumococcus, Streptococcus, and Staphylococcus; cases of fatal purulent cardiac tamponade have been recorded in the literature. Pericarditis is also caused by fungal organisms such as Blastomyces, Histoplasma, Coccidioides, and Candida, as well as parasitic species such as Toxoplasma and Echinococcus.

Malignant, connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus, Behçet’s disease, and metabolic etiologies are among the non-infectious causes such as myxedema and Uremia. Trauma can also produce pericarditis with an immediate onset or more commonly seen in clinical practice, a delayed inflammatory response. Checkpoint inhibitors, such as nivolumab and ipilimumab, have lately surfaced as a growing source of cardiac toxicity, including pericarditis and myocarditis.

Genetics

Prognostic Factors

The prognosis for acute pericarditis is favorable, with most patients recovering completely.

Recurrent pericarditis can develop in up to 30% of patients who are not treated with colchicine, while constrictive pericarditis is extremely rare after acute idiopathic pericarditis, occurring in just 1% of instances.

However, the likelihood of constriction rises with some etiologies, particularly purulent bacterial or TB pericarditis, and may reach 30%.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

rilonacept 

loading dose:

320

mg

Subcutaneous (SC)

Single dose


maintenance dose: 160 mg subcutaneously, administered once every week

note:
The drug is indicated for treating recurrent pericarditis and reducing the risk for recurrence



 

rilonacept 

Age: 12-17 years

loading dose:

4.4

mg/kg

Subcutaneous (SC)

total dose does not exceed 320 mg


maintenance dose: 2.2 mg/kg subcutaneous injection
dose not exceeding 160 mg or 2 mL per injection

Age: >18 years

loading dose: 320 mg subcutaneous injection once
maintenance dose: 160 mg subcutaneous injection once a week



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK431080/

Pericarditis

Updated : February 8, 2024




The most prevalent pathological disease involving the pericardium is pericarditis, which refers to inflammation of the pericardial sac. Other pericardial disorders, such as cardiac tamponade, pericardial effusion, effusive-constrictive pericarditis, and constrictive pericarditis, may be linked with pericarditis.

Pericardial inflammation is frequently associated with increased fluid buildup inside the pericardial sac, resulting in a pericardial effusion that can be hemorrhagic, purulent, or serous based on the cause.

This fluid buildup may become hemodynamically substantial, especially if the pericardial effusion is significant or the pace of accumulation is rapid since the fluid can externally compress the heart chambers, restricting diastolic filling and creating the cardiac tamponade syndrome. This can emerge as obstructive shock and is classified as a medical emergency that needs immediate attention.

Pericarditis is a leading cause of chest pain and one of the most prevalent type of pericardial disease. It is also linked with uremic patients, malignant illness, and trauma. It is more prevalent in men.

The pericardium performs several functions. It serves as a thoracic cavity anchor for the heart, creates a barrier against extrinsic infection, and improves dynamic contact within the cardiac chambers.

Despite considerations about higher cardiac mobility and displacement inside the chest cavity, investigations have demonstrated that individuals had similar left ventricular ejection fraction and life expectancy as the general population.

Because of the extensive innervation of the parietal layer, any inflammatory condition mediated by an autoimmune, infectious, or traumatic damage can result in significant retrosternal chest discomfort, as observed in acute pericarditis.

Viruses are the most prevalent infective agents, including echovirus, coxsackieviruses A & B, adenoviruses, HIV, parvovirus B19, influenza, and several herpes viruses, like CMV and EBV. Bacterial causes of pericarditis are uncommon in developed countries; nonetheless, TB infection is still widespread in underdeveloped nations and is considered the predominant cause of pericarditis in endemic areas.

Other bacteria that cause pericarditis include Meningococcus, Coxiella burnetii, Pneumococcus, Streptococcus, and Staphylococcus; cases of fatal purulent cardiac tamponade have been recorded in the literature. Pericarditis is also caused by fungal organisms such as Blastomyces, Histoplasma, Coccidioides, and Candida, as well as parasitic species such as Toxoplasma and Echinococcus.

Malignant, connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus, Behçet’s disease, and metabolic etiologies are among the non-infectious causes such as myxedema and Uremia. Trauma can also produce pericarditis with an immediate onset or more commonly seen in clinical practice, a delayed inflammatory response. Checkpoint inhibitors, such as nivolumab and ipilimumab, have lately surfaced as a growing source of cardiac toxicity, including pericarditis and myocarditis.

The prognosis for acute pericarditis is favorable, with most patients recovering completely.

Recurrent pericarditis can develop in up to 30% of patients who are not treated with colchicine, while constrictive pericarditis is extremely rare after acute idiopathic pericarditis, occurring in just 1% of instances.

However, the likelihood of constriction rises with some etiologies, particularly purulent bacterial or TB pericarditis, and may reach 30%.

rilonacept 

loading dose:

320

mg

Subcutaneous (SC)

Single dose


maintenance dose: 160 mg subcutaneously, administered once every week

note:
The drug is indicated for treating recurrent pericarditis and reducing the risk for recurrence



rilonacept 

Age: 12-17 years

loading dose:

4.4

mg/kg

Subcutaneous (SC)

total dose does not exceed 320 mg


maintenance dose: 2.2 mg/kg subcutaneous injection
dose not exceeding 160 mg or 2 mL per injection

Age: >18 years

loading dose: 320 mg subcutaneous injection once
maintenance dose: 160 mg subcutaneous injection once a week



https://www.ncbi.nlm.nih.gov/books/NBK431080/

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