Heart & vascular pathology

Inflammatory disease

Noninfective pericarditis

Last author update: 1 June 2014
Last staff update: 27 December 2021

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PubMed Search: Noninfective pericarditis

R. Amita, M.D.
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Cite this page: Amita R. Noninfective pericarditis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/heartnoninfecpericarditis.html. Accessed September 26th, 2023.
Definition / general
  • Pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub and serial ECG changes
  • Idiopathic pericarditis
  • Acute pericarditis
  • Chronic pericarditis
  • Chronic effusive pericarditis and chronic constrictive pericarditis
  • Recurrent pericarditis
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
Microscopic (histologic) images

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No granulomatous inflammation

Differential diagnosis
  • Myocardial infarction
Additional references
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