Pericarditis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pericarditis can present as a disorder primarily involving the pericardium (e.g viral etiologies), as manifestation of a systemic illness (e.g. autoimmune illnesses), or as a manifestation of a disorder involving an adjacent anatomic structure (e.g. cancer).
Common Causes of Pericarditis [1]
- (35%) Neoplastic
- (23%) Autoimmune
- (21%) Viral - adenovirus, enterovirus, influenza virus etc.
- ( 6%) Bacterial (other than tuberculosis)
- ( 6%) Uremia
- ( 4%) Tuberculosis
- ( 4%) Idiopathic
- (remaining) trauma, drugs, post-AMI, myocarditis, dissecting aortic aneurysm, radiation
Complete Differential Diagnosis of the Causes of Pericarditis
(By organ system)
| Cardiovascular | Post-MI pericarditis in the immediate days following acute MI and Dresslers syndrome which develops later; dissecting aortic aneurysm; and underlying myocarditis.
Following cardiovascular procedures such as: cathether ablation for arrhythmias, pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium, valvuloplasty. |
| Chemical / poisoning | No underlying causes |
| Dermatologic | Behcet syndrome |
| Drug Side Effect | Usually associated with small effusions. Common culprits include hydralazine, procainamide, DOH, isoniazid, phenylbutazone, dantrolene, doxorubicin, methylsergide, penicillin. |
| Ear Nose Throat | Temporal arteritis |
| Endocrine | Usually in conjunction with clinically severe hypothyroidism. Most early case reports associated with myxedema and patients also had ascites, pleural effusions and uveal edema. Often resolves with thyroid replacement therapy. A pericardial effusion can be seen as part of an Addisonian crisis. |
| Environmental | No underlying causes |
| Gastroenterologic | Inflammatory bowel disease, Whipple's |
| Genetic | No underlying causes |
| Hematologic | Leukemia, Lymphoma |
| Iatrogenic | Post-pericardiotomy syndrome,Radiation therapy, Chylopericardium (from thoracic duct obstruction secondary to tumor, surgical procedure. |
| Infectious Disease | Viral: Coxsackie B Virus, Echovirus, Adenovirus (less commonly: CMV-especially in HIV patients, EBV, Hepatitis B, Influenza, Mumps, Varicella).
Tuberculous: usually bloody, protein greater than 2.5. Initially mostly polymorphonuclear cells, later lymphocytes, monocytes and plasma cells. Usually develops very slowly with significant fibrous reaction. Initially effusive then becomes constrictive. Purulent: Pneumococcus, Streptococcus and Staphylococcus most common. Also Proteus, E.coli, Psuedomonas, Klebsiella, Brucellosis, Salmonella, Neisseria, Haemophilus influenza, Tularemia, Legionella, preodominantly by hematogenous spread and approximately 20% by contiguous spread. Usually these patients are quite ill. Fungal: Actinomycosis, Amebiasis, Aspergillus, Blastomycosis, Candida, Coccidiomycosis,Echinococcus, Histoplasmosis, Nocardia, Toxoplasmosis. Other: Borrelia, Francisella, Lyme disease (usually myopericarditis associated with conduction abnormalities)Mycoplasma. |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Predominantly lung cancer, breast cancer, leukemia, lymphomas (Hodgkins and non-Hodgkins). Less commonly GI malignancies, ovarian cancer, sarcomas and melanomas, metastic, hematogenous, carcinoma, carcinoid, Sipple syndrome, mesothelioma, fibroma, lipoma . Also Kaposis sarcoma in HIV positive patients. |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Sarcoidosis |
| Renal / Electrolyte | Uremic pericarditis is seen in up to 20% of uremic patients requiring chronic hemodialysis. The mechanism is unknown. Most commonly there is a small effusion associated with pain and a pericardial friction rub, but there can be a large effusion and present with tamponade |
| Rheum / Immune / Allergy | Systemic Lupus Erythematosus or SLE: Pericarditis usually occurs in the setting of disease flares (systemic symptoms, high erythrocyte sedimentation rate (ESR) , +ANA, +dsDNA, pleural effusions). Occurs in 20-40% of patients with SLE during the course of the disease. Usually the fluid is serous or grossly bloody. Analysis of the fluid usually reveals a high protein and low glucose content. Typically WBC count is less than 10K, and is made up of primarily polymorphonuclear cells (PMNs).
Rheumatoid arthritis or RA: Pericarditis can occur without active joint involvement. Also serous or bloody. Usually the protein is > 5 mg/dl, and the glucose is low (<45). The WBC is high at 20-90K. Complement is usually low, and the latex fixation test is usually positive. Other: Ankylosing Spondylitis, Behcet syndrome, mixed connective tissue disease, Familial Mediterranian Fever, poly arteritis nodosa PAN, acute rheumatic fever, scleroderma, temporal arteritis and , Wegener's. |
| Sexual | No underlying causes |
| Trauma | After blunt or penetrating chest trauma
Following cardiovascular procedures such as: cathether ablation for arrhythmias, pacemaker insertion, percutaneous coronary intervention with either dissection or perforation of the coronary artery, TAVI, thoracic surgery (resulting in chylopericardium, valvuloplasty. Following gastrointestinal catastrophes including esophageal rupture, pancreatic-pericardial fistula, esophogeal perforation, gastric perforation. |
| Urologic | No underlying causes |
| Miscellaneous | Amyloidosis, commonly the diagnosis is idiopathic. |
Differential Diagnosis of Causes of Acute Pericarditis
In alphabetical order:
- Actinomycosis
- Acute idiopathic pericarditis
- Acute rheumatic fever
- Adenovirus
- Addison's crisis
- Amyloidosis
- Amebiasis
- Ankylosing Spondylitis
- Aortic dissection
- Behcet's Disease
- Borrelia
- Breast cancer
- Chylopericardium
- Coxsackie A
- Coxsackie B
- Cytomegalovirus
- Dermatomyositis
- Dermatosclerosis
- Dressler's Syndrome
- EBV
- ECHO virus
- Echinococcosis
- Familial Mediterranian Fever
- Francisella
- HIV
- Infectious mononucleosis
- Inflammatory Bowel Disease
- Influenza virus
- Legionella
- Leukemia
- Lung cancer
- Lymphoma
- Meningococci
- Mixed Connective Tissue Disease
- Mumps virus
- Mycoplasma infection
- Neisseria gonorrhoeae
- Perforated esophagus
- Pneumococci
- Polyarteritis Nodosa
- Polymyositis
- Postpericardiotomy syndrome
- Reiter's Syndrome
- Radiation therapy
- Renal Failure
- Rheumatoid Arthritis
- Rickettsia
- Sarcoidosis
- Scleroderma
- Serum sickness
- Staphylococci
- Streptococci
- Systemic Lupus Erythematosus
- Thorax trauma
- Treponema pallidum
- Toxoplasmosis
- Tuberculosis
- Uremia
- Varicella virus
- Wegener's granulomatosis
- Whipple's Disease
Differential Diagnosis of Causes of Chronic Pericarditis
In alphabetical order:
- Amebiasis
- Bacterial infections
- Cholesterol pericarditis
- Chylopericardium
- Coccidioidomycosis
- Collagen Vascular Disease
- Coxsackie B
- Echinococcosis
- Histoplasmosis
- Neoplastic pericarditis
- Tuberculosis
- Uremic pericarditis
References
- ↑ Maisch B, Ristic AD (2002). "The classification of pericardial disease in the age of modern medicine". Curr Cardiol Rep. 4 (1): 13–21. doi:10.1007/s11886-002-0121-6. PMID 11743917.