Pericarditis natural history: Difference between revisions
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'''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S. | '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S. | ||
The prognosis associated with [[pericarditis]] depends on the underlying cause and associated condition(s). | |||
==Prognosis== | |||
===Idiopathic Pericarditis=== | |||
Idiopathic pericarditis is often self-limited and most patients recover in 2 weeks to 3 months. Idiopathic or viral pericarditis is associated with a favorable long-term prognosis<ref name="pmid1920818">{{cite journal| author=Ilan Y, Oren R, Ben-Chetrit E| title=Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients. | journal=Jpn Heart J | year= 1991 | volume= 32 | issue= 3 | pages= 315-21 | pmid=1920818 | doi= | pmc= | url= }} </ref>with few developing recurrences<ref name="pmid2249218">{{cite journal| author=Shabetai R| title=Acute pericarditis. | journal=Cardiol Clin | year= 1990 | volume= 8 | issue= 4 | pages= 639-44 | pmid=2249218 | doi= | pmc= | url= }} </ref>. Approximately 15-30% of patients with idiopathic acute pericarditis who are not treated with colchicine will develop recurrent pericarditis. | |||
===Post MI Pericarditis or Dressler's Syndrome=== | |||
Post [[MI]] pericarditis is usually associated with larger infarcts, and therefore these patients have a poorer long term prognosis. | |||
==Complications== | |||
===Pericardial Effusion=== | |||
Many forms of pericarditis can be complicated by significant fluid buildup around the heart, a condition known as a [[pericardial effusion]]. If the fluid accumulates too rapidly or is too large, then [[cardiac tamponade]], a condition in which the heart is compressed by the fluid and cannot pump enough blood forward may occur. [[Cardiac tamponade]] may require urgent intervention including [[pericardiocentesis]]. This complication is more common in patients with specific underlying etiologies such as [[malignancy]], [[tuberculosis]]<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref>, or purulent pericarditis and rarely occurs in idiopathic pericarditis. | |||
*In penetrating injuries, pericardial effusion and tamponade may rapidly develop. Early detection and treatment of [[cardiac tamponade]] has good prognosis. Minor perforations, isolated right ventricular wounds, systolic blood pressure more than 50 mm Hg have better outcomes. | *In penetrating injuries, pericardial effusion and tamponade may rapidly develop. Early detection and treatment of [[cardiac tamponade]] has good prognosis. Minor perforations, isolated right ventricular wounds, systolic blood pressure more than 50 mm Hg have better outcomes. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Varun Kumar, M.B.B.S.
The prognosis associated with pericarditis depends on the underlying cause and associated condition(s).
Prognosis
Idiopathic Pericarditis
Idiopathic pericarditis is often self-limited and most patients recover in 2 weeks to 3 months. Idiopathic or viral pericarditis is associated with a favorable long-term prognosis[1]with few developing recurrences[2]. Approximately 15-30% of patients with idiopathic acute pericarditis who are not treated with colchicine will develop recurrent pericarditis.
Post MI Pericarditis or Dressler's Syndrome
Post MI pericarditis is usually associated with larger infarcts, and therefore these patients have a poorer long term prognosis.
Complications
Pericardial Effusion
Many forms of pericarditis can be complicated by significant fluid buildup around the heart, a condition known as a pericardial effusion. If the fluid accumulates too rapidly or is too large, then cardiac tamponade, a condition in which the heart is compressed by the fluid and cannot pump enough blood forward may occur. Cardiac tamponade may require urgent intervention including pericardiocentesis. This complication is more common in patients with specific underlying etiologies such as malignancy, tuberculosis[3], or purulent pericarditis and rarely occurs in idiopathic pericarditis.
- In penetrating injuries, pericardial effusion and tamponade may rapidly develop. Early detection and treatment of cardiac tamponade has good prognosis. Minor perforations, isolated right ventricular wounds, systolic blood pressure more than 50 mm Hg have better outcomes.
- Pericarditis associated with scleroderma, rheumatic fever, purulent, tuberculosis, or malignancy have complicated courses with worse outcomes. Mortality rate of tuberculous pericarditis in preantibiotic era was 80-90%[4]. Mortality rate currently is 8-17%[5][6] and 17-34% if associated with HIV[7].
- Patients with renal failure are associated with significant morbidity and may develop hemorrhagic pericarditis[8]
- If scarring of the sac around the heart (the pericardium) occurs, then this is called constrictive pericarditis which may require surgical stripping of the scar.
References
- ↑ Ilan Y, Oren R, Ben-Chetrit E (1991). "Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients". Jpn Heart J. 32 (3): 315–21. PMID 1920818.
- ↑ Shabetai R (1990). "Acute pericarditis". Cardiol Clin. 8 (4): 639–44. PMID 2249218.
- ↑ Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.
- ↑ Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94
- ↑ Desai HN (1979). "Tuberculous pericarditis. A review of 100 cases". S Afr Med J. 55 (22): 877–80. PMID 472922.
- ↑ Bhan GL (1980). "Tuberculous pericarditis". J Infect. 2 (4): 360–4. PMID 7185934.
- ↑ Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A (2000). "Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients". Heart. 84 (2): 183–8. PMC 1760932. PMID 10908256.
- ↑ Nicholls, AJ. Heart and Circulation. In: Handbook of Dialysis, Daugirdas, JT, Ing, TS (Eds), Little, Brown and Co., New York 1994. p.149.