Pericarditis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D. Homa Najafi, M.D.[2]

Overview

Pericarditis may be classified according to the composition of the inflammatory exudate into 6 subtypes: serous, purulent, fibrinous, caseous, hemorrhagic, and post-infarction or Dressler's syndrome. Pericarditis can also be classified into acute and chronic forms, depending on the timing of presentation and duration.

Classification

Pericarditis can be classified according to the composition of the inflammatory exudate or the composition of the fluid that accumulates around the heart. Types include:

• Serous
• Purulent
• Fibrinous
• Caseous
• Hemorrhagic
• Post infarction or Dressler's Syndrome

Pericarditis classification based on etiology

Infectious causes

Non-infectious causes

Viral: Enteroviruses (coxsackieviruses, echoviruses) Herpes viruses (EBV, CMV, HHV-6) Adenoviruses Parvovirus B19

Bacterial: Mycobacterium tuberculosis Coxiella burnetii Borrelia burgdorferi

Fungal: Histoplasma species Aspergillus species Blastomyces species Candida species

Parasitic: Echinococcus species Toxoplasma species

Autoimmune: Systemic autoimmune and auto-inflammatory diseases Systemic vasculitides Sarcoidosis Familial Mediterranean fever IBD Still disease

Neoplastic: Primary tumours (pericardial mesothelioma) Secondary metastatic tumours ( lung and breast cancer, lymphoma).

Metabolic: Uraemia Myxoedema Anorexia nervosa

Traumatic and Iatrogenic

Drug-related

Others: Amyloidosis Aortic dissection Pulmonary arterial Hypertension Chronic heart failure Congenital absence of the pericardium

Acute Versus Chronic Pericarditis

Depending on the timing of presentation and duration, pericarditis can be classified into "acute" and "chronic" forms. Clinically, acute pericarditis presents between 6 weeks to 6 months of the disease onset; subacute pericarditis presents within 6 weeks to 6 months of the disease onset, and chronic pericarditis manifests after 6 months of the disease onset. Acute pericarditis is more common than chronic pericarditis, and often occurs as a complication of viral infections, immunologic conditions, or as a result of a heart attack (myocardial infarction). Chronic pericarditis is less common. It may manifest as scarring of the pericardium, which is a condition known as constrictive pericarditis.