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[Pericarditis: classification, etiology, pathogenesis]
1I Kliniki Kardiologii Akademii Medycznej im. M. Kopernika, Krakowie.
Abstract:
The most frequent pericardial diseases are inflammations which in surviving patients are recognized much less frequently comparing with autopsy material. The most frequent causes of pericarditis include various infections, inflammations associated with systemic diseases, acute myocardial infarction, traumas and iatrogenic lesions, and neoplasms. Viral etiology is most often in infectious pericarditis. A considerable percentage of idiopathic pericarditis is most probably of such etiology. Bacterial (purulent) pericarditis in contrast to viral one is characterized by high mortality and frequent progression of acute to chronic type. The latter with the symptoms of pericardial constriction occurs in at least 50% of the patients with tuberculous etiology irrespective of specific treatment. In recent years the number of iatrogenic pericarditis has increased related to hypersensitivity or autoimmunity. One should mention here post-cardiotomy syndrome, pacemaker implantation, diagnostic procedures such as biopsy, cardiac catheterization, hypersensitivity to drugs and radiation pericarditis as a complication of therapy.
Insights
Pericardial diseases, mainly inflammations, are often underdiagnosed in living patients. Infections, systemic diseases, and iatrogenic causes are frequent triggers for pericarditis.
Area of Science:
- Cardiology
- Pathology
- Internal Medicine
Background:
- Pericardial diseases, particularly inflammations, are frequently observed in autopsy studies but less recognized in surviving patients.
- Common etiologies include infections (viral, bacterial, tuberculous), systemic inflammatory conditions, myocardial infarction, trauma, neoplasms, and iatrogenic factors.
- Viral infections are the most common cause of infectious pericarditis, with a significant portion of idiopathic cases likely sharing this etiology.
Purpose of the Study:
- To review the epidemiology and diverse etiologies of pericardial diseases.
- To highlight the diagnostic challenges and varying prognoses associated with different causes of pericarditis.
- To emphasize the increasing incidence of iatrogenic pericarditis and its contributing factors.
Main Methods:
- Review of existing literature on pericardial diseases.
- Analysis of etiological factors and clinical presentations.
- Comparison of diagnostic frequency between clinical and autopsy findings.
Main Results:
- Viral pericarditis is common, while bacterial pericarditis has high mortality and progression to chronic constrictive pericarditis.
- Tuberculous pericarditis frequently leads to constrictive pericarditis, even with treatment.
- Iatrogenic pericarditis, including post-cardiotomy syndrome and complications from procedures or therapies, is increasingly recognized.
Conclusions:
- Pericarditis presents with diverse causes and clinical outcomes, necessitating accurate etiological diagnosis.
- Prompt recognition and management are crucial, especially for high-mortality conditions like bacterial and tuberculous pericarditis.
- The rise in iatrogenic pericarditis underscores the importance of monitoring complications from medical interventions.