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, cytomegalovirus, influenza virus, hepatitis B virus, and herpes simplex 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 (Dresslers), Dissecting aortic aneurysm |
| 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. |
| 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: Mumps, Influenza, varicella, Hepatitis B and CMV-especially in HIV patients.) Usually associated with a viral prodrome and acute pericarditis.
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| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | Predominantly lung, breast, 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).
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| Sexual | No underlying causes |
| Trauma | After chest trauma, throacic surgery, PCM insertion, Valvuloplasty. Also from esophageal rupture, pancreatic-pericardial fistula (check amylase), penetrating chest injury, esophogeal perforation, gastric perforation, during catheterization (pacemaker insertion, cathether ablation for arrhythmias, diagnostic, PCI with coronary dissection). |
| Urologic | No underlying causes |
| Miscellaneous | Amyloidosis |
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.