Pericarditis: Causes, Risk Factors, and Associated Conditions

Introduction

Pericarditis is the inflammation of the pericardium, the thin, double-layered sac surrounding the heart. It can cause chest pain, pericardial effusion (fluid accumulation), and complications such as cardiac tamponade. The causes of pericarditis can be diverse, ranging from infections to autoimmune disorders. Understanding these causes is crucial for effective diagnosis and treatment.

Causes of Pericarditis

1. Infectious Causes

• Viral Infections (most common): Coxsackievirus, echovirus, influenza, HIV
• Bacterial Infections: Tuberculosis (TB), pneumococcal, staphylococcal, and streptococcal infections
• Fungal Infections: Histoplasmosis, aspergillosis
• Parasitic Infections: Toxoplasmosis, echinococcosis

2. Non-Infectious Causes

• Autoimmune & Inflammatory Diseases: Lupus, rheumatoid arthritis, scleroderma, Sjögren’s syndrome
• Post-myocardial infarction (Dressler’s Syndrome): Inflammatory reaction after a heart attack
• Post-cardiac surgery or trauma: Pericardial inflammation following cardiac interventions
• Uremia (Kidney Failure): Accumulation of toxins affecting the pericardium in end-stage renal disease
• Cancers & Metastases: Lung cancer, breast cancer, lymphoma affecting the pericardium
• Radiation Therapy: Previous radiation to the chest area can cause chronic pericardial inflammation

3. Medication-Induced Pericarditis

Some drugs can trigger pericardial inflammation, such as: - Hydralazine - Procainamide - Isoniazid - Chemotherapeutic agents

4. Metabolic Disorders

Conditions like hypothyroidism or hypercholesterolemia can contribute to pericardial inflammation indirectly.

Conclusion

Pericarditis is a complex condition with multiple potential causes. Identifying the underlying cause is crucial for appropriate treatment, whether that involves antiviral therapy, antibiotics, anti-inflammatory medications, or addressing underlying systemic disease.

References

The following are clinical guidelines that cover the diagnosis, causes, and management of pericarditis:

Source recommendations

1. 2015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases

1. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
2. https://pubmed.ncbi.nlm.nih.gov/26320112/
3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
4. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases
5. https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/2015-esc-guidelines-on-the-diagnosis-and-management-of-pericardial-diseases

2. American College of Cardiology/American Heart Association Guidelines on Pericardial Disease

1. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases
2. https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
3. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/01/07/10/59/Management-of-Acute-and-Recurrent-Pericarditis
4. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
5. https://www.acc.org/Clinical-Topics/Pericardial-Disease