Pericarditis laboratory studies: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pericarditis}} | {{Pericarditis}} | ||
{{CMG}}; | {{CMG}}; {{AE}}[[Varun Kumar, M.B.B.S.]]{{Homa}} | ||
==Overview== | ==Overview== | ||
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*[[Anti-dsDNA antibody]] | *[[Anti-dsDNA antibody]] | ||
== | ==2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)<ref name="AdlerCharron2015">{{cite journal|last1=Adler|first1=Yehuda|last2=Charron|first2=Philippe|last3=Imazio|first3=Massimo|last4=Badano|first4=Luigi|last5=Barón-Esquivias|first5=Gonzalo|last6=Bogaert|first6=Jan|last7=Brucato|first7=Antonio|last8=Gueret|first8=Pascal|last9=Klingel|first9=Karin|last10=Lionis|first10=Christos|last11=Maisch|first11=Bernhard|last12=Mayosi|first12=Bongani|last13=Pavie|first13=Alain|last14=Ristić|first14=Arsen D.|last15=Sabaté Tenas|first15=Manel|last16=Seferovic|first16=Petar|last17=Swedberg|first17=Karl|last18=Tomkowski|first18=Witold|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>== | ||
== | ===Recommendations for the general diagnostic work-up of pericardial diseases=== | ||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' In all cases of suspected [[pericardial disease]] a first [[diagnostic]] evaluation is recommended with: | |||
– [[auscultation]] | |||
– [[ECG]] | |||
– [[transthoracic echocardiography]] | |||
– [[chest X-ray]] | |||
– routine [[blood tests]], including markers of [[inflammation]] (i.e., [[CRP]] and/or [[ESR]]), white [[blood cell count]] with differential count, [[renal function]] and [[Liver function tests|liver tests]] and [[myocardial]] [[Lesions|lesion]] [[Test|tests]] ([[CK]], [[Troponin|troponins]]). | |||
'''2.''' [[CT]] and/or [[CMR]] are recommended as [[second]]-level [[testing]] for [[diagnostic]] workup in pericarditis. | |||
'''3.''' [[Pericardiocentesis]] or [[Drain (surgery)|surgical drainage]] are [[Indication (medicine)|indicated]] for [[cardiac tamponade]] or suspected [[bacterial]] and [[neoplastic pericarditis]]. | |||
'''4.''' Further testing is [[Indication (medicine)|indicated]] in high-risk [[patients]] (defined as above) according to the [[clinical]] [[conditions]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>It is recommended to search for independent predictors of an identifiable and specifically treatable cause of pericarditis (i.e. [[bacterial]], [[neoplastic]], [[systemic]] [[inflammatory diseases]]). Major factors include: | |||
– [[fever]] >38 C | |||
– [[subacute]] [[Course (medicine)|course]] ([[symptoms]] developing over several days or weeks) | |||
– large [[pericardial effusion]] ([[diastolic]] echo-free space >20 mm in width) | |||
– [[cardiac tamponade]] | |||
– [[failure]] of [[Aspirin]] or [[NSAIDs]] ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])<ref name="ImazioDemichelis2004">{{cite journal|last1=Imazio|first1=Massimo|last2=Demichelis|first2=Brunella|last3=Parrini|first3=Iris|last4=Giuggia|first4=Marco|last5=Cecchi|first5=Enrico|last6=Gaschino|first6=Gianni|last7=Demarie|first7=Daniela|last8=Ghisio|first8=Aldo|last9=Trinchero|first9=Rita|title=Day-hospital treatment of acute pericarditis|journal=Journal of the American College of Cardiology|volume=43|issue=6|year=2004|pages=1042–1046|issn=07351097|doi=10.1016/j.jacc.2003.09.055}}</ref><ref name="ImazioCecchi2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Cecchi|first2=Enrico|last3=Demichelis|first3=Brunella|last4=Ierna|first4=Salvatore|last5=Demarie|first5=Daniela|last6=Ghisio|first6=Aldo|last7=Pomari|first7=Franco|last8=Coda|first8=Luisella|last9=Belli|first9=Riccardo|last10=Trinchero|first10=Rita|title=Indicators of Poor Prognosis of Acute Pericarditis|journal=Circulation|volume=115|issue=21|year=2007|pages=2739–2744|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.662114}}</ref>'' | |||
''<nowiki/>'' | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon" |<nowiki></nowiki> [[Percutaneous]] or [[surgical]] [[pericardial]] [[biopsy]] may be considered in selected cases of suspected [[neoplastic]] or [[tuberculous pericarditis]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence:]]<nowiki/> [[ACC AHA Guidelines Classification Scheme#Level of Evidence|C]])'' | |||
|} | |||
===Recommendations for diagnosis of acute pericarditis=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[ECG]] is recommended in all [[patients]] with suspected [[acute pericarditis]]. | |||
'''2.''' [[Transthoracic echocardiography]] is recommended in all [[patients]] with suspected [[acute pericarditis]]. | |||
'''3.''' [[Chest X-rays|Chest X-ray]] is recommended in all [[patients]] with suspected [[Acute pericarditis|acute pericarditis.]] | |||
'''4.''' Assessment of markers of [[inflammation]] (i.e. [[CRP]]) and [[myocardial]] [[injury]] (i.e. [[CK]], [[troponin]]) is recommended in [[patients]] with suspected [[acute pericarditis]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
===Recommendations for the diagnosis and therapy of viral pericarditis=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon" |<nowiki></nowiki> For the definited [[diagnosis]] of [[viral pericarditis]], a comprehensive workup of [[histological]], [[cytological]], [[Immunohistochemistry|immunohistological]] and [[molecular]] investigations in [[pericardial fluid]] and peri-/[[epicardial]] [[biopsies]] should be considered. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]]<nowiki/>)'' | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightCoral"|[[ESC guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
|bgcolor="LightCoral" |<nowiki></nowiki> '''1.''' Routine [[viral]] [[serology]] is not recommended, with the possible exception of [[Human Immunodeficiency Virus (HIV)|HIV]] and [[Hepatitis C|HCV]]. | |||
'''2.''' [[Corticosteroid]] [[therapy]] is not recommended in [[viral pericarditis]]. (''[[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
===Recommendations for the diagnosis of purulent pericarditis=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[Urgent care|Urgent]] [[pericardiocentesis]] is recommended for the [[diagnosis]] of [[purulent pericarditis]]. | |||
'''2.''' It is recommended that [[pericardial fluid]] be sent for [[bacterial]], [[fungal]] and [[tuberculous]] studies and [[blood]] drawn for cultures. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | |||
''<nowiki/>'' | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Medicine]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 23:39, 29 July 2020
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Pericarditis Microchapters |
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Pericarditis laboratory studies On the Web |
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American Roentgen Ray Society Images of Pericarditis laboratory studies |
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Risk calculators and risk factors for Pericarditis laboratory studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. Homa Najafi, M.D.[2]
Overview
Non-specific markers of inflammation are generally elevated in pericarditis. These include the leukocyte count, C-reactive protein, and ESR. The cardiac troponin is elevated if there is an injury to the underlying myocardium, a condition termed as myopericarditis. Diagnostic pericardiocentesis and biopsy help in identifying an underlying infectious or malignant process.
Inflammatory Markers
The following inflammatory markers are often elevated:
- CBC: Significant leukocytosis may be present.
- C-reactive protein
- Erythrocyte sedimentation rate (ESR)
Cardiac Biomarkers
The following markers of myonecrosis may be elevated if there is involvement of the underlying myocardium:
- Creatine kinase: Acute pericarditis may be associated with a modest increase in serum creatine kinase-MB (CK-MB) depending upon the extent of involvement of the underlying myocardium.[1][2]
- Cardiac troponin-I (cTnI)[3][4]: The troponin can be elevated if there is an underlying myositis, or a myopericarditis. In Europe, patients with pericarditis and an elevated troponin are hospitalized briefly to assure that the patient is stable.
- LDH: Serum LDH may be elevated depending upon the extent of myocardial involvement.
- Serum myoglobin
- SGOT (AST)
Autoimmune Markers
Following autoimmune markers may be checked in patients with recurrent or prolonged pericarditis:
2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)[5]
Recommendations for the general diagnostic work-up of pericardial diseases
| Class I |
| 1. In all cases of suspected pericardial disease a first diagnostic evaluation is recommended with:
– ECG – transthoracic echocardiography – routine blood tests, including markers of inflammation (i.e., CRP and/or ESR), white blood cell count with differential count, renal function and liver tests and myocardial lesion tests (CK, troponins). 2. CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis. 3. Pericardiocentesis or surgical drainage are indicated for cardiac tamponade or suspected bacterial and neoplastic pericarditis. 4. Further testing is indicated in high-risk patients (defined as above) according to the clinical conditions. (Level of Evidence: C)
|
| Class I |
| It is recommended to search for independent predictors of an identifiable and specifically treatable cause of pericarditis (i.e. bacterial, neoplastic, systemic inflammatory diseases). Major factors include:
– fever >38 C – subacute course (symptoms developing over several days or weeks) – large pericardial effusion (diastolic echo-free space >20 mm in width) – failure of Aspirin or NSAIDs (Level of Evidence: B)[6][7]
|
| Class IIb |
| Percutaneous or surgical pericardial biopsy may be considered in selected cases of suspected neoplastic or tuberculous pericarditis. (Level of Evidence: C) |
Recommendations for diagnosis of acute pericarditis
| Class I |
| 1. ECG is recommended in all patients with suspected acute pericarditis.
2. Transthoracic echocardiography is recommended in all patients with suspected acute pericarditis. 3. Chest X-ray is recommended in all patients with suspected acute pericarditis. 4. Assessment of markers of inflammation (i.e. CRP) and myocardial injury (i.e. CK, troponin) is recommended in patients with suspected acute pericarditis. (Level of Evidence: C)
|
Recommendations for the diagnosis and therapy of viral pericarditis
| Class IIa |
| For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered. (Level of Evidence: C) |
| Class III |
| 1. Routine viral serology is not recommended, with the possible exception of HIV and HCV.
2. Corticosteroid therapy is not recommended in viral pericarditis. (Level of Evidence: C)
|
Recommendations for the diagnosis of purulent pericarditis
| Class I |
| 1. Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis.
2. It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. (Level of Evidence: C)
|
References
- ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
- ↑ Karjalainen J, Heikkila J (1986). ""Acute pericarditis": myocardial enzyme release as evidence for myocarditis". Am Heart J. 111 (3): 546–52. doi:10.1016/0002-8703(86)90062-1. PMID 3953365.
- ↑ Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". Eur Heart J. 21 (10): 832–6. doi:10.1053/euhj.1999.1907. PMID 10781355.
- ↑ Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R (2003). "Cardiac troponin I in acute pericarditis". J Am Coll Cardiol. 42 (12): 2144–8. doi:10.1016/j.jacc.2003.02.001. PMID 14680742.
- ↑ Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
- ↑ Imazio, Massimo; Demichelis, Brunella; Parrini, Iris; Giuggia, Marco; Cecchi, Enrico; Gaschino, Gianni; Demarie, Daniela; Ghisio, Aldo; Trinchero, Rita (2004). "Day-hospital treatment of acute pericarditis". Journal of the American College of Cardiology. 43 (6): 1042–1046. doi:10.1016/j.jacc.2003.09.055. ISSN 0735-1097.
- ↑ Imazio, Massimo; Cecchi, Enrico; Demichelis, Brunella; Ierna, Salvatore; Demarie, Daniela; Ghisio, Aldo; Pomari, Franco; Coda, Luisella; Belli, Riccardo; Trinchero, Rita (2007). "Indicators of Poor Prognosis of Acute Pericarditis". Circulation. 115 (21): 2739–2744. doi:10.1161/CIRCULATIONAHA.106.662114. ISSN 0009-7322.