open access

Vol 78, No 5 (2020)
Review paper
Published online: 2020-05-11
Get Citation

Noninfectious pericarditis: management challenges for cardiologists

Massimo Imazio
DOI: 10.33963/KP.15353
·
Pubmed: 32394692
·
Kardiol Pol 2020;78(5):396-403.

open access

Vol 78, No 5 (2020)
Review article
Published online: 2020-05-11

Abstract

The aim of this review is to deal with management challenges related to diagnosis and therapy of noninfectious pericarditis. In the European countries in which a low prevalence of tuberculosis is noted, determining the etiology of pericarditis is essentially aimed at the exclusion of the most common causes, which may require a specific therapy and are associated with an increased risk of complications: systemic autoimmune or autoinflammatory diseases, postcardiac injury syndrome (5%–20%), neoplastic pericardial involvement (5%–10%), tuberculosis (about 5%), and rarely purulent pericarditis in less than 5% of cases. In developing countries that report a high prevalence of tuberculosis, this condition is the most common cause of pericardial diseases. The diagnosis is based on clinical criteria (pericarditis‑related chest pain and pericardial rubs) complemented by laboratory (elevated levels of C‑reactive protein) and imaging findings (electrocardiography, echocardiography, and other imaging modalities to provide evidence of pericardial inflammation in doubtful cases). Poor prognostic predictors (high fever > 38 °C, subacute course, large pericardial effusion, cardiac tamponade, and lack of response to empiric anti‑inflammatory therapies) identify high‑risk patients who should be admitted to the hospital in order to determine disease etiology and receive appropriate treatment. The mainstay of medical therapy of noninfectious pericarditis is based on nonsteroidal anti‑inflammatory drugs and colchicine, with possible adjunct of corticosteroids at low‑to‑moderate doses in unresponsive patients. Additional therapies, particularly with anakinra, have been implemented for those who develop corticosteroid dependence and are colchicine‑resistant. Disease recurrence is the most common and troublesome complication of pericarditis, whereas the risk of developing constrictive pericarditis is related to the etiology and not to the number of recurrences.

Abstract

The aim of this review is to deal with management challenges related to diagnosis and therapy of noninfectious pericarditis. In the European countries in which a low prevalence of tuberculosis is noted, determining the etiology of pericarditis is essentially aimed at the exclusion of the most common causes, which may require a specific therapy and are associated with an increased risk of complications: systemic autoimmune or autoinflammatory diseases, postcardiac injury syndrome (5%–20%), neoplastic pericardial involvement (5%–10%), tuberculosis (about 5%), and rarely purulent pericarditis in less than 5% of cases. In developing countries that report a high prevalence of tuberculosis, this condition is the most common cause of pericardial diseases. The diagnosis is based on clinical criteria (pericarditis‑related chest pain and pericardial rubs) complemented by laboratory (elevated levels of C‑reactive protein) and imaging findings (electrocardiography, echocardiography, and other imaging modalities to provide evidence of pericardial inflammation in doubtful cases). Poor prognostic predictors (high fever > 38 °C, subacute course, large pericardial effusion, cardiac tamponade, and lack of response to empiric anti‑inflammatory therapies) identify high‑risk patients who should be admitted to the hospital in order to determine disease etiology and receive appropriate treatment. The mainstay of medical therapy of noninfectious pericarditis is based on nonsteroidal anti‑inflammatory drugs and colchicine, with possible adjunct of corticosteroids at low‑to‑moderate doses in unresponsive patients. Additional therapies, particularly with anakinra, have been implemented for those who develop corticosteroid dependence and are colchicine‑resistant. Disease recurrence is the most common and troublesome complication of pericarditis, whereas the risk of developing constrictive pericarditis is related to the etiology and not to the number of recurrences.

Get Citation
About this article
Title

Noninfectious pericarditis: management challenges for cardiologists

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 78, No 5 (2020)

Article type

Review paper

Pages

396-403

Published online

2020-05-11

Page views

582

Article views/downloads

515

DOI

10.33963/KP.15353

Pubmed

32394692

Bibliographic record

Kardiol Pol 2020;78(5):396-403.

Authors

Massimo Imazio

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl