eMedicine Specialties > Cardiology > Pericardial Disease

Pericarditis, Acute: Follow-up

Author: Sean Spangler, MD, Cardiology Fellow, Brooke Army Medical Center
Coauthor(s): Garrett S Lynchard, MD, Consulting Cardiologist, Brooke Army Medical Center, Fort Sam Houston; Philip J Gentlesk, MD, Director, Cardiac Electrophysiology, Section of Cardiovascular Disease, Brooke Army Medical Center
Contributor Information and Disclosures

Updated: Mar 3, 2008

Follow-up

Complications

  • Recurrence (can cause significant morbidity, secondary to pain)
  • Cardiac tamponade
  • Constrictive pericarditis
  • Combination of effusive and constrictive pericarditis

Prognosis

  • The prognosis depends on the etiology.
  • Idiopathic and viral etiologies usually have a self-limited course.
  • Purulent, tuberculous, and neoplastic pericardial involvement have more complicated courses with worse outcomes.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Avoid NSAIDs and corticosteroids in AMI pericarditis because they may interfere with ventricular healing, remodeling, or both.
  • Pericarditis can be difficult to distinguish from myocardial infarction and repolarization in patients who present with chest pain and ST-segment elevation on ECG.
    • Aside from clues elicited from the history and physical examination, repolarization does not progress through stages and is uncommonly associated with PR depression. Serial monitoring of ECGs in young patients with chest pain helps differentiate early repolarization from acute pericarditis.
    • An ST-segment–to–T-wave ratio of greater than or equal to 0.25 in V6 can distinguish acute pericarditis from early repolarization.
    • The ST segment in AMI is usually convex, bowing upward with reciprocal changes, as opposed to concave ST segments without reciprocal changes observed in acute pericarditis and repolarization.

Special Concerns

  • Children may present with abdominal pain.
  • The classic feature of chest pain and dyspnea with pericarditis may be subtle and can be confused with other diagnoses, particularly in elderly individuals.
 


More on Pericarditis, Acute

Overview: Pericarditis, Acute
Differential Diagnoses & Workup: Pericarditis, Acute
Treatment & Medication: Pericarditis, Acute
Follow-up: Pericarditis, Acute
Multimedia: Pericarditis, Acute
References
[ CLOSE WINDOW ]

References

  1. Lorell BH. Pericardial Diseases. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 5th ed. Philadelphia, Pa: WB Saunders; 1997:1478-534.

  2. Brady WJ, Perron AD, Martin ML, Beagle C, Aufderheide TP. Cause of ST segment abnormality in ED chest pain patients. Am J Emerg Med. Jan 2001;19(1):25-8. [Medline].

  3. Sagristà-Sauleda J, Barrabes JA, Permanyer-Miralda G. Purulent pericarditis: review of a 20-year experience in a general hospital. J Am Coll Cardiol. Nov 15 1993;22(6):1661-5. [Medline].

  4. Soler-Soler J, Permanyer-Miralda G, Sagristà-Sauleda J. A systematic diagnostic approach to primary acute pericardial disease. The Barcelona experience. Cardiol Clin. Nov 1990;8(4):609-20. [Medline].

  5. Silva-Cardoso J, Moura B, Martins L, Mota-Miranda A, Rocha-Gonçalves F, Lecour H. Pericardial involvement in human immunodeficiency virus infection. Chest. Feb 1999;115(2):418-22. [Medline].

  6. Eckart RE, Love SS, Atwood JE, Arness MK, Cassimatis DC, Campbell CL, et al. Incidence and follow-up of inflammatory cardiac complications after smallpox vaccination. J Am Coll Cardiol. Jul 7 2004;44(1):201-5. [Medline].

  7. Imazio M, Demichelis B, Cecchi E. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. Dec 17 2003;42(12):2144-8. [Medline].

  8. Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. Mar 17 2004;43(6):1042-6. [Medline].

  9. Adler Y, Finkelstein Y, Guindo J, Rodriguez de la Serna A, Shoenfeld Y, Bayes-Genis A, et al. Colchicine treatment for recurrent pericarditis. A decade of experience. Circulation. Jun 2 1998;97(21):2183-5. [Medline].

  10. Angomachalelis N, Hourzamanis A, Salem N, Vakalis D, Serasli E, Efthimiadis T, et al. Pericardial effusion concomitant with specific heart muscle disease in systemic sarcoidosis. Postgrad Med J. 1994;70 Suppl 1:S8-12. [Medline].

  11. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. Aug 4 2004;44(3):E1-E211. [Medline].

  12. Arunasalam S, Siegel RJ. Rapid resolution of symptomatic acute pericarditis with ketorolac tromethamine: a parenteral nonsteroidal antiinflammatory agent. Am Heart J. May 1993;125(5 Pt 1):1455-8. [Medline].

  13. Baljepally R, Spodick DH. PR-segment deviation as the initial electrocardiographic response in acute pericarditis. Am J Cardiol. Jun 15 1998;81(12):1505-6. [Medline].

  14. Brook I, Frazier EH. Microbiology of acute purulent pericarditis. A 12-year experience in a military hospital. Arch Intern Med. Sep 9 1996;156(16):1857-60. [Medline].

  15. Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med. Mar 1981;70(3):519-30. [Medline].

  16. Callahan JA, Seward JB, Nishimura RA, Miller FA Jr, Reeder GS, Shub C, et al. Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients. Am J Cardiol. Feb 1 1985;55(4):476-9. [Medline].

  17. Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J. Mar 1999;137(3):516-21. [Medline].

  18. Correale E, Maggioni AP, Romano S, Ricciardiello V, Battista R, Santoro E. Pericardial involvement in acute myocardial infarction in the post-thrombolytic era: clinical meaning and value. Clin Cardiol. Apr 1997;20(4):327-31. [Medline].

  19. Dacso CC. Pericarditis in AIDS. Cardiol Clin. Nov 1990;8(4):697-9. [Medline].

  20. Fairley CK, Ryan M, Wall PG, Weinberg J. The organisms reported to cause infective myocarditis and pericarditis in England and Wales. J Infect. May 1996;32(3):223-5. [Medline].

  21. Fowler NO. Recurrent pericarditis. Cardiol Clin. Nov 1990;8(4):621-6. [Medline].

  22. Friedman PL, Brown EJ Jr, Gunther S, Alexander RW, Barry WH, Mudge GH Jr, et al. Coronary vasoconstrictor effect of indomethacin in patients with coronary-artery disease. N Engl J Med. Nov 12 1981;305(20):1171-5. [Medline].

  23. Friman G, Fohlman J. The epidemiology of viral heart disease. Scand J Infect Dis Suppl. 1993;88:7-10. [Medline].

  24. Ginzton LE, Laks MM. The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Circulation. May 1982;65(5):1004-9. [Medline].

  25. Gregoratos G. Pericardial involvement in acute myocardial infarction. Cardiol Clin. Nov 1990;8(4):601-8. [Medline].

  26. Guevara R, Aguinaga-Meza M, Hazin MI, Hazin R, McCord J. Takotsubo cardiomyopathy complicated with acute pericarditis and cardiogenic shock. J Natl Med Assoc. Mar 2007;99(3):281-3. [Medline].

  27. Gunukula SR, Spodick DH. Pericardial disease in renal patients. Semin Nephrol. Jan 2001;21(1):52-6. [Medline].

  28. Hall IP. Purulent pericarditis. Postgrad Med J. Jul 1989;65(765):444-8. [Medline].

  29. Hancock EW. Neoplastic pericardial disease. Cardiol Clin. Nov 1990;8(4):673-82. [Medline].

  30. Hoit BD. Imaging the pericardium. Cardiol Clin. Nov 1990;8(4):587-600. [Medline].

  31. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. Sep 27 2005;112(13):2012-6. [Medline].

  32. Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A, et al. Indicators of poor prognosis of acute pericarditis. Circulation. May 29 2007;115(21):2739-44. [Medline].

  33. Imazio M, Demichelis B, Parrini I, Favro E, Beqaraj F, Cecchi E, et al. Relation of acute pericardial disease to malignancy. Am J Cardiol. Jun 1 2005;95(11):1393-4. [Medline].

  34. Juneja R, Kothari SS, Saxena A, Sharma R, Joshi A. Intrapericardial streptokinase in purulent pericarditis. Arch Dis Child. Mar 1999;80(3):275-7. [Medline].

  35. Khan AH. The postcardiac injury syndromes. Clin Cardiol. Feb 1992;15(2):67-72. [Medline].

  36. Klacsmann PG, Bulkley BH, Hutchins GM. The changed spectrum of purulent pericarditis: an 86 year autopsy experience in 200 patients. Am J Med. Nov 1977;63(5):666-73. [Medline].

  37. Komsuoglu B, Göldelï O, Kulan K, Komsuoglu SS. The diagnostic and prognostic value of adenosine deaminase in tuberculous pericarditis. Eur Heart J. Aug 1995;16(8):1126-30. [Medline].

  38. Krainin FM, Flessas AP, Spodick DH. Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram. N Engl J Med. Nov 8 1984;311(19):1211-4. [Medline].

  39. Krikorian JG, Hancock EW. Pericardiocentesis. Am J Med. Nov 1978;65(5):808-14. [Medline].

  40. Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med. Nov 18 2004;351(21):2195-202. [Medline].

  41. Lorbar M, Spodick DH. 'Idiopathic' pericarditis--the clinician's challenge [nothing is idiopathic]. Int J Clin Pract. Jan 2007;61(1):138-42. [Medline].

  42. Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment. Curr Opin Cardiol. May 1994;9(3):379-88. [Medline].

  43. Maisch B, Pankuweit S, Brilla C, Funck RC, Simon BC, Grimm W, et al. Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsy--results from a pilot study. Clin Cardiol. Jan 1999;22(1 Suppl 1):I17-22. [Medline].

  44. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmüller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. Apr 2004;25(7):587-610. [Medline].

  45. Maruyama T, Hanaoka T, Nakajima H. Acute pericarditis in the recovery phase of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy). Intern Med. 2007;46(22):1857-60. [Medline].

  46. Mehta M, Jain AC, Mehta A. Early repolarization. Clin Cardiol. Feb 1999;22(2):59-65. [Medline].

  47. Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?. Am J Med. Aug 1998;105(2):106-9. [Medline].

  48. Moder KG, Miller TD, Tazelaar HD. Cardiac involvement in systemic lupus erythematosus. Mayo Clin Proc. Mar 1999;74(3):275-84. [Medline].

  49. Moores DW, Dziuban SW Jr. Pericardial drainage procedures. Chest Surg Clin N Am. May 1995;5(2):359-73. [Medline].

  50. Mueller XM, Tevaearai HT, Hurni M, Ruchat P, Fischer AP, Stumpe F, et al. Etiologic diagnosis of pericardial disease: the value of routine tests during surgical procedures. J Am Coll Surg. Jun 1997;184(6):645-9. [Medline].

  51. Permanyer-Miralda G, Sagristà-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. Oct 1 1985;56(10):623-30. [Medline].

  52. Posner MR, Cohen GI, Skarin AT. Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis. Am J Med. Sep 1981;71(3):407-13. [Medline].

  53. Rombola F, Spinoso A, Bertuccio SN. [Cardiac manifestations during viral acute hepatitis]. Infez Med. Mar 2006;14(1):29-32. [Medline].

  54. Rostand SG, Rutsky EA. Pericarditis in end-stage renal disease. Cardiol Clin. Nov 1990;8(4):701-7. [Medline].

  55. Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J. Tuberculous pericarditis: ten year experience with a prospective protocol for diagnosis and treatment. J Am Coll Cardiol. Apr 1988;11(4):724-8. [Medline].

  56. Sagristà-Sauleda J, Permanyer-Miralda G, Candell-Riera J, Angel J, Soler-Soler J. Transient cardiac constriction: an unrecognized pattern of evolution in effusive acute idiopathic pericarditis. Am J Cardiol. Apr 15 1987;59(9):961-6. [Medline].

  57. Shabetai R. Acute pericarditis. Cardiol Clin. Nov 1990;8(4):639-44. [Medline].

  58. Spodick DH. Arrhythmias during acute pericarditis. A prospective study of 100 consecutive cases. JAMA. Jan 5 1976;235(1):39-41. [Medline].

  59. Spodick DH. Diagnostic electrocardiographic sequences in acute pericarditis. Significance of PR segment and PR vector changes. Circulation. Sep 1973;48(3):575-80. [Medline].

  60. Spodick DH. Differential diagnosis of acute pericarditis. Prog Cardiovasc Dis. Sep 1971;14(2):192-209. [Medline].

  61. Spodick DH. Electrocardiogram in acute pericarditis. Distributions of morphologic and axial changes by stages. Am J Cardiol. Apr 1974;33(4):470-4. [Medline].

  62. Spodick DH. Frequency of arrhythmias in acute pericarditis determined by Holter monitoring. Am J Cardiol. Mar 1 1984;53(6):842-5. [Medline].

  63. Spodick DH. Pericardial rub. Prospective, Multiple observer investigation of pericardial friction in 100 patients. Am J Cardiol. Mar 1975;35(3):357-62. [Medline].

  64. Spodick DH. Pericarditis in systemic diseases. Cardiol Clin. Nov 1990;8(4):709-16. [Medline].

  65. Spodick DH. The normal and diseased pericardium: current concepts of pericardial physiology, diagnosis and treatment. J Am Coll Cardiol. Jan 1983;1(1):240-51. [Medline].

  66. Stevenson LW, Child JS, Laks H, Kern L. Incidence and significance of early pericardial effusions after cardiac surgery. Am J Cardiol. Oct 1 1984;54(7):848-51. [Medline].

  67. Sugiura T, Takehana K, Abe Y, Kamihata H, Karakawa M, Hatada K, et al. Frequency of pericardial friction rub ("pericarditis") after direct percutaneous transluminal coronary angioplasty in Q-wave acute myocardial infarction. Am J Cardiol. Feb 1 1997;79(3):362-4. [Medline].

  68. Tuna IC, Danielson GK. Surgical management of pericardial diseases. Cardiol Clin. Nov 1990;8(4):683-96. [Medline].

  69. Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford). Oct 2006;45 Suppl 4:iv4-7. [Medline].

  70. Wall TC, Califf RM, Harrelson-Woodlief L, Mark DB, Honan M, Abbotsmith CW, et al. Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group. Am J Cardiol. Dec 15 1990;66(20):1418-21. [Medline].

  71. Weiss JM, Spodick DH. Association of left pleural effusion with pericardial disease. N Engl J Med. Mar 24 1983;308(12):696-7. [Medline].

  72. Wenger NK. Pericardial disease in the elderly. Cardiovasc Clin. 1992;22(2):97-103. [Medline].

  73. Winkler WB, Karnik R, Slany J. Treatment of exudative fibrinous pericarditis with intrapericardial urokinase. Lancet. Dec 3 1994;344(8936):1541-2. [Medline].

  74. Wong B, Murphy J, Chang CJ, Hassenein K, Dunn M. The risk of pericardiocentesis. Am J Cardiol. Nov 1979;44(6):1110-4. [Medline].

  75. Zayas R, Anguita M, Torres F, Giménez D, Bergillos F, Ruiz M, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. Feb 15 1995;75(5):378-82. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

acute pericarditis, pericardial disease, pericardium, heart disease, cardiac disease, inflamed pericardium, pericardial inflammation, chest pain, pericardial friction rub, heart infection, cardiac infection, pericardial infection, tuberculosis, bacterial heart infection, viral heart infection, rheumatoid arthritis, systemic lupus erythematosus, lupus erythematosus, SLE, scleroderma, sarcoidosis, rheumatic fever, renal failure, kidney failure, hypothyroidism, cholesterol pericarditis, myocardial infarction, Dressler syndrome, cardiac neoplasm, pericardiocentesis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Sean Spangler, MD, Cardiology Fellow, Brooke Army Medical Center
Sean Spangler, MD is a member of the following medical societies: American College of Cardiology and American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Garrett S Lynchard, MD, Consulting Cardiologist, Brooke Army Medical Center, Fort Sam Houston
Garrett S Lynchard, MD is a member of the following medical societies: American College of Cardiology and American College of Physicians
Disclosure: Nothing to disclose.

Philip J Gentlesk, MD, Director, Cardiac Electrophysiology, Section of Cardiovascular Disease, Brooke Army Medical Center
Philip J Gentlesk, MD is a member of the following medical societies: American College of Cardiology, Christian Medical & Dental Society, and Heart Rhythm Society
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, and Heart Rhythm Society
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.