Pericarditis is caused by what?

Written by Liu Ying
Cardiology
Updated on September 22, 2024
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Pericarditis refers to the inflammatory disease of the visceral and parietal layers of the pericardium. It can be classified according to its etiology into infectious, non-infectious, allergic, and immune pericarditis. Causes of infectious pericarditis include viral, purulent, tuberculous, and fungal pericarditis. Non-infectious pericarditis can be caused by acute myocardial infarction, uremia, tumors, trauma, aortic dissection, radiation, acute idiopathic, and sarcoidosis, among others. Causes of allergic or immune pericarditis include rheumatic, vasculitis, drugs, and more. Some patients remain undiagnosed after examinations and are categorized as having idiopathic pericarditis or nonspecific pericarditis.

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Written by Xiong Hong Hai
Infectious Disease
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Is tuberculous pericarditis hereditary?

Tuberculous pericarditis is an infectious disease, not a hereditary disease. Most cases are due to tuberculosis of the lungs, after which the tuberculosis bacteria enter the bloodstream and cause tuberculous pericarditis in the pericardium. Tuberculous pericarditis is curable. If it is confirmed to be tuberculous pericarditis, it is necessary to start anti-tuberculosis treatment as soon as possible. It may also be necessary to combine some corticosteroids for treatment. With standardized anti-tuberculosis and symptomatic supportive treatment, it can generally be completely cured. Analysis should be tailored to the actual situation.

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Written by Tang Li
Cardiology
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What are the types of pericarditis?

Pericarditis includes primary infectious pericarditis, as well as non-infectious pericarditis caused by related diseases, such as tumors, metabolic diseases, autoimmune diseases, and uremia. Based on the progression of the condition, pericarditis can also be divided into acute pericarditis, with or without pericardial effusion, chronic pericarditis, adhesive pericarditis, subacute exudative constrictive pericarditis, and chronic constrictive pericarditis. Clinically, acute pericarditis and chronic constrictive pericarditis are the most common.

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Written by Liu Ying
Cardiology
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Early symptoms of acute pericarditis

The early symptoms of acute pericarditis are pain, which is located behind the sternum or in the precordial area, typically seen in the fibrin exudative type of inflammation. This pain arises from the friction between the visceral pericardium and the parietal pericardium. The nature of the pain is very sharp and related to respiratory movement, commonly exacerbated by coughing, deep breathing, or swallowing. The pain can radiate to the neck, left shoulder, and left arm. As fluid accumulates in the pericardium and the two layers of the pericardium separate, the pain may decrease or disappear.

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Written by Liu Ying
Cardiology
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Constrictive pericarditis clinical manifestations

Patients with constrictive pericarditis often have a history of pericarditis, pericardial effusion, malignant tumors, and other diseases. Some patients have an insidious onset with no obvious clinical symptoms in the early stages. The main symptoms can include palpitations, exertional dyspnea, decreased exercise tolerance, fatigue, enlarged liver, pleural effusion, abdominal effusion, and edema of the lower limbs. Patients with constrictive pericarditis commonly present with elevated jugular venous pressure, and often have a reduced pulse pressure. Most patients exhibit a negative apical beat during systole, with a commonly faster heart rate. The rhythm can be sinus, atrial, or ventricular, with premature contractions possible, as well as Kussmaul's sign. In the late stages, muscle atrophy, cachexia, and severe edema can occur.

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Written by Tang Li
Cardiology
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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.