Why Does Pericarditis Happen?
The etiology of pericarditis remains a mystery among the clinical experts. The quick recognition of a likely cause of pericarditis may be critical. It is frequently referred to as idiopathic in 80% of the cases, even though the viral infection is the most common triggering factor. Acute pericarditis often occurs after severe respiratory infection. Chronic or recurring pericarditis is generally the outcome of autoimmune diseases which include lupus, scleroderma and rheumatoid arthritis. Myocardial dysfunction, renal disease, HIV, malignancy, TB, drugs, and radiation are some of the possible causes of pericarditis. It usually affects young and middle-aged people and often recurs some times.
One of the fascinating research studies says two rare genetic auto-inflammatory disorders can target pericardium and triggers inflammation. They are Familial Mediterranean Fever (FMF) and Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS). Nearly 20% of cases are associated with cardiac diseases, cancer or connective tissue disorder. Patients with myocardial infarction usually present this disease within 2 to 4 days and sometimes late in Dressler’s syndrome. But, occasionally, patients show symptomatic pericarditis after clinically silent myocardial infarction.
Tuberculous pericarditis is the cause of 70% of cases in developing and third world countries. It has high mortality followed by HIV associated pericarditis. In well-developed countries, very less than 5% of cases reported. Immigration could possibly increase these cases in developed countries. Neoplastic pericardial, systemic inflammatory diseases and pericardial injury syndromes, and purulent pericarditis are identified in unselected populations. Primary tumors and secondary metastatic tumors like lung and breast cancer, and lymphoma are etiology of pericarditis. Certain metabolic disorder like Uremia, myxedema, and anorexia nervosa are a rare factor for this condition.
Coxiella burnetii, Borrelia burgdorferi, Histoplasma, Aspergillus, Blastomyces, Candida, Echinococcus and Toxoplasma species infection are some of the microbial agent responsible for pericarditis. Certain drugs induce pericarditis such as procainamide, hydralazine, methyldopa, isoniazid, and phenytoin. Penicillins and antineoplastic drugs include doxorubicin, daunorubicin, cytosine arabinoside, fluorouracil, and cyclophosphamide can able to cause pericarditis.
Pericardial effusions are common after cardiac surgery. Chest tube removal after surgery is often risk associated. It may be one of the causing factors for postoperative pericardial effusions, which require invasive treatment. The increase in abnormal accumulation of fluid depends on the underlying etiology. In many cases, it is idiopathic i.e. the reason is not predictable. One of the purposes is lack of extensive diagnostic evaluation. In case of constrictive pericarditis, a thickened fibrotic pericardium is the reason for pericarditis which obstructs normal diastolic filling. Acute and subacute forms of pericarditis sometimes deposit fibrin, which can induce a pericardial effusion. This frequently causes pericardial inflammation, chronic fibrotic scarring, calcification, and restricted cardiac filling. In rare cases, both conditions occur which is referred to as effusive-constrictive pericarditis. An effusion persisting for months to years may evolve into effusive-constrictive pericarditis.
Pericarditis can range from mild sickness that gets better on its own, to a life-threatening condition. Chest pain is the common symptoms associated with all types of pericarditis. It is typically sharp and can be prevented by leaning position or sitting up. Classically, the pain begins in the center of the chest and radiates to the neck or upper back. Pericarditis affects people of all ages, gender, and races. Among those treated for acute pericarditis, 15 to 30 percent may get it again, with a small number eventually developing chronic pericarditis.
Recurrent pericarditis is generally manifested by the recurrence of acute pericarditis symptoms after resolution and elimination of the inciting agent. This form develops in 30% of acute pericarditis patients not treated with colchicine, usually within 18 to 20 months after the initial acute pericarditis episode, but may occur after longer periods. The disease usually has a relapsing-remitting pattern, but may be more chronic in some cases.
Currently, European Society of Cardiology Guidelines for the diagnosis and management of pericarditis recommends combination therapy with aspirin or a non-steroidal anti-inflammatory drug (NSAID) tapered over 3 to 4 weeks, plus colchicine therapy for 3 to 6 months, as part of first-line therapy for the treatment of idiopathic pericarditis.
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