Heart
Inflammatory heart disease
Noninfective pericarditis

Author: R. Amita, M.D. (see Authors page)

Revised: 19 March 2018, last major update June 2014

Copyright: (c) 2014-2018, PathologyOutlines.com, Inc.

PubMed Search: Noninfective pericarditis

Cite this page: Amita, R. Noninfective pericarditis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/heartnoninfecpericarditis.html. Accessed July 21st, 2018.
Definition / general
  • Pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub and serial ECG changes
Terminology
  • Idiopathic pericarditis
  • Acute pericarditis
  • Chronic pericarditis
  • Chronic effusive pericarditis and chronic constrictive pericarditis
  • Recurrent pericarditis
Pathophysiology
  • The acute inflammatory response in pericarditis can produce either serous or purulent fluid or a dense fibrinous material
  • Neoplastic, tuberculous, and purulent pericarditis may be associated with large effusions that are hemorrhagic and exudative
  • Prolonged pericarditis may result in persistent accumulation of pericardial fluid which may form a thick coating that surrounds the myocardium causing constrictive pericarditis
Etiology
  • Idiopathic: No identifiable etiology found after routine testing
  • Specific causes:
    • Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever
    • Myocardial infarction (Dressler syndrome)
    • Trauma to the heart, e.g. puncture, resulting in infection or inflammation
    • Uremia (uremic pericarditis)
    • Malignancy (as a paraneoplastic phenomenon)
    • Side effect of medication, e.g. isoniazid, cyclosporine, hydralazine, warfarin, heparin
    • Radiation induced
    • Aortic dissection
    • Tetracyclines
    • Postpericardiotomy syndrome: usually after CABG surgery
Clinical features
  • Chest pain, usually precordial or retrosternal
  • Low grade intermittent fever
  • Dyspnea / tachypnea
  • Cough and dysphagia
  • Malignancy associated pericarditis: fever, night sweats, and weight loss are common
Diagnosis
  • Initial evaluation includes a clinical history and physical examination, ECG, echocardiography, chest radiography, lab studies
  • 12 lead electrocardiogram shows diffuse, nonspecific, concave, ST segment elevation in all leads except aVR and V1; also PR segment depression is possible in any lead except aVR; sinus tachycardia and low voltage QRS complexes may be seen if subsymptomatic levels of pericardial effusion
  • The PR depression is often seen early in the process as the thin atria are affected more easily than the ventricles by the inflammatory process of the pericardium
Laboratory
  • Increased urea (BUN) or increased blood creatinine in uremic pericarditis
  • Troponin (I, T), CK-MB, myoglobin, and LDH1 (Lactase Dehydrogenase isotype 1) may be normal or elevated
Case reports
Treatment
  • Aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Pericardiocentesis to treat pericardial effusion / tamponade
  • Antibiotics to treat tuberculosis or other bacterial causes
  • Steroids are not recommended because they increase the risk of recurrent pericarditis
  • Pericardiectomy in rare cases
Prognosis
  • Generally, acute pericarditis is benign and self limiting
  • Complications include tamponade, constriction, or recurrence
  • Nearly 50% will have recurrence
Gross description
  • Epicardial surface appears roughened compared to its normal glistening appearance; this is due to strands of pink-tan fibrin
Gross images

Images hosted on other servers:
Missing Image

Serous fluid at bottom of pericardial cavity (slide 60)

Missing Image

Firbinous exudate in pericardial sac

Microscopic (histologic) images

Images hosted on other servers:
Missing Image

No granulomatous inflammation

Missing Image

Various images

Differential diagnosis
  • Myocardial infarction
Additional references