eMedicine Specialties > Cardiology > Pericardial Disease

Pericarditis, Acute: Treatment & Medication

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

Treatment

Medical Care

  • Oxygen and a cardiac monitor should be provided. Rule out other life-threatening causes of chest pain, such as myocardial infarction or aortic dissection. Evaluate for evidence of hemodynamic instability. Consider whether further management is safe to continue on an outpatient basis. In a recent study, fever of more than 38°C, subacute onset, immunosuppression, trauma, oral anticoagulation therapy, aspirin or NSAID failure, myopericarditis, severe pericardial effusion, and cardiac tamponade were designated as poor prognostic predictors. Patients without these factors were treated on an outpatient basis without serious complications after a mean follow-up of 38 months.8
  • Given an overall lack of specificity of clinical features, several authors describe diagnostic protocols to determine the etiology for pericarditis.
    • Following specific protocols, several authors have determined a specific etiology in 14-22% of patients.
    • In one study, cardiac tamponade and an unfavorable clinical outcome, with persistence of fever, significant pericardial effusion, or general illness lasting longer than a week, was highly associated with finding a specific etiology.
    • Initial evaluation includes clinical history and physical examination, chest radiograph, ECG, echocardiography as indicated, and initial laboratory work.
    • Consider thoracentesis with adenosine deaminase in addition to conventional studies in patients with a pleural effusion.
    • Pericardiocentesis should be performed on all patients with cardiac tamponade or suspected purulent pericarditis.

Surgical Care

  • If tamponade recurs after pericardiocentesis, perform a pericardial biopsy with histologic and bacteriologic examinations of the pericardium.
  • If significant clinical activity persists for 3 weeks after admission and without an etiologic diagnosis, some authors recommend pericardial biopsy.

Consultations

  • Consult a cardiologist or internist for acute and idiopathic cases.
  • In complicated cases, such as tuberculous, purulent uremic etiologies require multidisciplinary involvement, including consultations with a cardiologist, cardiac surgeon, and medical subspecialists (eg, infectious diseases specialist, nephrologist).

Medication

Treatment for specific causes of pericarditis is directed according to the underlying cause. For patients with idiopathic or viral pericarditis, therapy is directed at symptom relief. NSAIDs are the mainstay of therapy. These agents have a similar efficacy with relief of chest pain in about 85-90% of patients within days of treatment. Ibuprofen has the advantage of few adverse effects and increased coronary flow. Indomethacin has a poor adverse effect profile and reduces coronary flow.

Aspirin is recommended for treatment of pericarditis after STEMI.

Colchicine, in combination with an NSAID can be considered in the initial treatment to prevent recurrent pericarditis. Colchicine, alone or in combination with an NSAID, can be considered for patients with recurrent or continued symptoms beyond 14 days.

Corticosteroids should not be used for initial treatment of pericarditis unless it is indicated for the underlying disease, the patient has no response to NSAIDs or colchicine, or both are contraindicated.

Nonsteroidal anti-inflammatory drugs

These agents are effective for chest discomfort and underlying inflammation.


Indomethacin (Indocin)

Classic treatment; rapidly absorbed. Metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation.

Adult

50 mg PO q8h

Pediatric

1.5-2.5 mg/kg/d PO divided tid

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and possibly toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; GI bleeding or renal insufficiency

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur (discontinue if persistent leukopenia, granulocytopenia, or thrombocytopenia occurs); lower extremity edema possible; allergic hepatitis may occur (rare)


Ketorolac (Toradol)

Small studies have documented rapid relief of symptoms with 1-2 doses. Inhibits prostaglandin synthesis by decreasing activity of enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors.

Adult

30-90 mg IV/IM, repeat with 30 mg IV/IM in 1 h prn

Pediatric

Not established

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding; do not administer into CNS

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low WBC counts (rare) usually return to normal during ongoing therapy; discontinue therapy if persistent leukopenia, granulocytopenia, or thrombocytopenia occur


Ibuprofen (Motrin, Advil)

Usually DOC for mild to moderate pain if no contraindications exist.
Inhibits inflammatory reactions and pain, probably by decreasing the activity of the enzyme cyclooxygenase, which results in prostaglandin synthesis.

Adult

400-800 mg PO q4-8h

Pediatric

<6 months: Not established
6 months to 12 years: 10-70 mg/kg/d PO divided tid/qid; start at the lower end of dosing range and titrate upward to a maximum of 2.4 g/d
>12 years: Administer as in adults

Coadministration with aspirin increases risk of inducing serious NSAID-related side effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy

Anti-inflammatory agents

These agents reduce the effects of immune reactions.


Colchicine

Used for recurrent pericarditis. Decreases leukocyte motility and phagocytosis observed in inflammatory responses.

Adult

1 mg/d PO

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Sympathomimetic agent toxicity and effect of CNS depressants significantly increase

Documented hypersensitivity; severe renal, hepatic, GI, or cardiac disorders; blood dyscrasias

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Risk of renal failure, hepatic failure, permanent hair loss, bone marrow suppression, numbness or tingling in hands and feet, disseminated intravascular coagulopathy, and decreased sperm count; dose-dependent GI upset is common

Salicylates

These agents reduce inflammation.


Aspirin (Anacin, Bayer Aspirin, Ascriptin)

Used for pericarditis secondary to myocardial infarction. Inhibits prostaglandin synthesis and blocks prostaglandin synthetase action, which prevents formation of the platelet-aggregating thromboxane A2. Full doses are unsafe during pregnancy.

Adult

650 mg PO q6h

Pediatric

60-90 mg/kg/d PO divided q6h

Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with coadministration of anticoagulants; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses > 2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs

Documented hypersensitivity; liver damage, hypoprothrombinemia, vitamin K deficiency, bleeding disorders, asthma; because of the association of aspirin with Reye syndrome, do not use in children (<16 y) with flu

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, with history of blood coagulation defects, or those taking anticoagulants

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Multimedia: Pericarditis, Acute
References
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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].

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Further Reading

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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

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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.

 
 
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