Diagnosis has historically been based upon a combination of clinical history, examination, ecg findings, inflammatory markers and echocardiographic findings of pericardial thickening and effusion. At least two of the following four criteria must be present for the diagnosis. The acute form is defined as newonset inflammation lasting acute pericarditis, is the only tracing with stsegment elevation in both precordial leads and lead ii and prsegment depression. The main complication of acute pericarditis is pericardial effusion triggering cardiac tamponade. Acute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and selflimited, and may occur as an isolated entity or as a manifestation of a systemic disease.
Constrictive pericarditis arises from a stiffening of the pericardium, which prevents complete or satisfactory diastolic filling of the heart. Acute pericarditis has a number of potential etiologies including infection, acute myocardial infarction, medication use, trauma to the thoracic cavity, and systemic diseases, such as rheumatoid. Workup for a potential secondary cause was negative and a diagnosis of acute viral pericarditis was made. The chest pain of acute pericarditis typically is retrosternal in location, sudden in onset, and pleuritic in nature, in that it is exacerbated by inspiration. A more classic example of pericarditis with effusion is shown in figure 3. The 2015 esc guidelines for the diagnosis and management of pericardial diseases divided the etiology of acute pericarditis into two. The diagnosis of acute pericarditis requires at least two of the following symptoms or signs to be present. For most patients, this consisted of either 800 mg of aspirin or 600 mg of ibuprofen given orally every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks. However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and. Background colchicine is effective for the treatment of recurrent pericarditis. A casecontrol study article pdf available in bmj open 511.
Acute pericarditis is the most common form of pericardial disease that results in the need for empirical antiinflammatory treatment. A randomized trial of colchicine for acute pericarditis nejm. The typical complaint of acute pericarditis is chest pain, which radiates to one or both trapezius muscle ridges. Disclosure forms provided by the author are available with the full text of this article at nejm. A history and laboratory tests, a chest radiograph, and an echocardiogram are used in evaluation. Acute pericarditis is a common cardiovascular condition that may present in primary and secondary care settings. Ms, mpas, pac journal of the american academy of physician assistants. Constrictive pericarditisa curable diastolic heart. Tracing 4 shows a pseudoinfarction pattern in a patient with hyperkalemia. The recent cope trial indicates a better outcome if all patients receive a 3month course of colchicine.
Due to the subacute nature of the presentation and his fever, the patient was admitted for further assessment. Data presented at the 2014 american college of cardiology annual scientific session 2 attempted to systematically study a series of chest pain patients for evaluation of pericarditis by cardiac mri using t2 weighted and late gadolinium imaging sequences. Similar to the data reported for recurrent pericarditis, both trials showed that colchicine, when added to conventional antiinflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis in patients with acute pericarditis. Necropsy studies suggest a prevalence of approximately 1%. Acute myocardial infarction can also cause pericarditis, but the presenting symptoms often differ enough to warrant diagnosis. However, in developed countries up to 85% of acute pericarditis is caused by viral or idiopathic origins. The t wave in v 3 is tall, narrow, pointed, and tented. Apr 02, 2019 acute pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub, and serial ecg changes. These agents are used for symptom control and to reduce the risk of further.
In patients with acute pericarditis, colchicine, when added to conventional anti. Acute pericarditis is a type of pericarditis inflammation of the sac surrounding the heart, the pericardium usually lasting less than 6 weeks. Pdf acute pericarditis as a rare presentation of cardiac. An audible friction rub will often be noted with widespread stsegment elevation as the expression of subepicardial myocardial involvement. Imazio m, cecchi e, demichelis b, ierna s, demarie d. In contrast to our suggestions, the esc guidelines recommend rapid tapering to reduce the risk of systemic side effects.
Widespread stsegment elevation, considered characteristic of pericarditis, can be found in no more than 60% of patients with acute pericarditis and is more common in younger male patients, especially in association with myocarditis. A randomized trial of colchicine for acute pericarditis. The first and last stages of ecg changes are seen in the images below. Pericarditis is a common disorder that has multiple causes and presents in various primarycare and secondarycare settings. A history and laboratory tests, a chest radiograph, and an echocardiogram are used. The etiology of acute pericarditis is not clear in many of the cases, with less than 20% of patients designated a specific etiological diagnosis. An electrocardiogram reveals stsegment elevations in multiple leads, which are consistent with acute pericarditis. Acute pericarditis, inflammation of the pericardium, is found in approximately 5% of patients admitted to the. Lancet 2014 mar 30 in a new trial, an old drug is a safe and beneficial adjunct to nonsteroidal antiinflammatory drugs, even in patients with multiple recurrences. Acute pericarditis in the united states is usually idiopathic and presumed to be viral. Jun 28, 2012 acute pericarditis can develop from a wide variety of inflammatory diseases. Treatment of acute and recurrent idiopathic pericarditis. Some investigators presumed that the idiopathic index attack was post.
Reviewed here is the latest on diagnosis, treatment and follow up of acute pericarditis. Pdf acute recurrent pericarditis accompanied by graves disease. Acute pericarditis due to connective tissue disease uremic pericarditis. A randomized trial of colchicine for acute pericarditis article pdf available in new england journal of medicine 36916.
If the laboratory data support the clinical diagnosis, symptomatic treatment with aspirin or nonsteroidal antiinflammatory drugs nsaids with gastroprotection should be initiated. Pdf is acute idiopathic pericarditis associated with recent. Acute pericarditis typically is a selflimited disease, usually idiopathic or of viral origin, that responds to treatment with nsaids. Despite this advance, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures. The major clinical manifestations of acute pericarditis include pleuritic chest pain, pericardial friction rub, and ecg changes, with or without a pericardial effusion. Acute pericarditis is a selflimiting disease without significant complications or recurrences in 70% to 90% of patients. Colchicine in pericarditis european heart journal oxford.
However, a case of acute recurrent pericarditis accompanied by graves disease was reported and published by koo et al. Cmr in the diagnosis of acute pericarditis journal of. Acute pericarditis has been reported to recur in 30%, and in 1530% of subjects with pericarditis of unknown origin not treated with colchicine. Tracing 5 is from a patient with acute anteroseptal. Treatment usually includes an nsaid and colchicine. Pdf a randomized trial of colchicine for acute pericarditis. Mar 05, 2003 contemporary understanding of acute pericarditis rests on 3 main considerations1. Regarding clinical management and therapy of acute pericarditis, it is not mandatory to search for the aetiology in all patients, especially in countries with a low prevalence of tuberculosis tb because of the relatively benign course associated with the common. Pericarditis is an inflammation of the pericardium. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Cardiac tamponade is present in 5% to 15% of patients with acute idio pathic pericarditis and in 60% of those with neoplastic, tuberculous, or purulent peri carditis.
May 19, 2014 mounting evidence supports colchicine for pericarditis beat j. In developed countries, 80 to 90% of cases are idiopathic and presumed to be viral. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease. The real incidence and prevalence of pericarditis is difficult to quantify. It is often worse when the patient is supine and improves when he or she sits upright and leans forward. Transthoracic echocardiography tte demonstrated a trivial effusion with normal left ventricular systolic and diastolic function. Pericarditis symptoms, diagnosis and treatment bmj best. Mounting evidence supports colchicine for pericarditis. However, conclusive data are lacking regarding the use of.
In the openlabel colchicine in acute pericarditis cope trial, 120 patients with a first episode of acute pericarditis were randomized to receive colchicine 0. Apr 02, 2019 acute pericarditis is an inflammation of the pericardium characterized by pericarditic chest pain, pericardial friction rub, and serial electrocardiographic ecg changes eg, new widespread stelevation or pr depression. Acute recurrent pericarditis accompanied by graves disease. All patients also received conventional treatment for acute pericarditis. Acute pericarditis as a rare presentation of cardiac involvement in sarcoidosis article pdf available january 2017 with 63 reads how we measure reads. Acute pericarditis is the most common condition affecting the pericardium. In a multicenter, doubleblind trial, eligible adults with acute pericarditis were randomly assigned to receive either colchicine at a dose of 0. Aspirin and other nonsteroidal antiinflammatory drugs, prednisone, and colchicine are the mainstays of therapy. Jun 07, 2017 these trials included 120 and 240 patients, respectively, all recruited in italian centres. It is the most common condition affecting the pericardium. A previously healthy 25yearold man presents with pleuritic pain in the left side of the chest of 3 hours duration. Is acute idiopathic pericarditis associated with recent upper respiratory tract infection or gastroenteritis.
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