is an inflammation
) of the pericardium
(the fibrous sac surrounding the heart). Pericarditis is further classified according to the composition of the inflammatory exudate
: serous, purulent, fibrinous, and hemorrhagic types are distinguished.
Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or heart attack.
, radiating to the back and relieved by sitting up forward and worsened by lying down, is the classical presentation. Other symptoms of pericarditis may include dry cough
, fatigue, and anxiety
. Pericarditis can be misdiagnosed as myocardial infarction
(heart attack), and vice versa.
The classic sign of pericarditis is a friction rub. Other signs include diffuse ST-elevation and PR-depression on ECG (all leads); cardiac tamponade (pulsus paradoxus with hypotension), and congestive heart failure (elevated jugular venous pressure with peripheral edema).
Since the mid-19th Century, retrospective diagnosis of pericarditis has been made upon the finding of adhesions of the pericardium.
Most cases of acute idiopathic pericarditis resolve without complications or recurrence.
Complications may include:
Fibrinous pericarditis is an exudative inflammation. The pericardium is infiltrated by the fibrinous exudate. This consists of fibrin strands and leukocytes. Fibrin describes an amorphous, eosinophilic (pink) network. Leukocytes (mainly neutrophils) are found within the fibrin deposits and intrapericardic. Vascular congestion is also present. The myocardium has no changes. Sometimes referred to as having "Bread and Butter Appearance". Photo at: Atlas of Pathology
Pericarditis due to tuberculosis
Pericarditis caused by tuberculosis
is difficult to diagnose, because definitive diagnosis requires culturing Mycobacterium tuberculosis
from aspirated pericardial
fluid or pericardial biopsy
, which requires high technical skill and is often not diagnostic (the yield from culture is low even with optimum specimens). The Tygerberg scoring system
helps the clinician to decide whether pericarditis is due to tuberculosis or whether it is due to another cause: night sweats (1 point), weight loss (1 point), fever (2 point), serum globulin > 40g/l (3 points), blood total leucocyte count <10 x 109
/l (3 points); a total score of 6 or more is highly suggestive of tuberculous pericarditis. Pericardial fluid with an interferon-γ
level greater than 50picogram
/ml is highly specific for tuberculous pericarditis.
The treatment in viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs
. Severe cases may require: