The cardiovascular diseases

THE ACUTE PERICARDITIS

- Definition
- The Symptoms
- How to make the diagnosis?
- Diagnosis of assess gravity
- The Causes
- Evolution
- Treatment
- Conclusion

THE CAUSES OF A PERICARDITIS

Sometimes, the pericarditis is immediately connected to a more general illness, better known or not (whose inaugural expression it then constitutes), but in other cases, the cause is not easy to find: an exact cause is found in only 10 to 15% of the cases.

Thus, the physician should lead an investigation according to the following plan:

1 - He must first of all interrogate his patient, in search of tuberculosis antecedents, chronic inflammatory illness, or cancer. The clinical exam will search for some signs also in favour of an illness responsible for the pericarditis.

2 - Then, an x-ray of the thorax will be achieved, very often followed by a thorax scanner.

The puncture and the biopsy of the pericardium can only be debated if the evolution is longer than 4 or 6 weeks or especially a compression of the heart by the extrusion forces the physician to intervene quickly. The puncture of the pericardium under local anaesthesia permits analysing the liquid.

The biopsy of the pericardium under general anaesthesia is more interesting than the analysis of the liquid but sometimes it is not very precise. An experienced surgeon must achieve it and point it at a sick suspected area.

The different causes of a pericarditis are:

1 - The viral pericarditis

These are most frequent but very often the cardiologist cannot precisely identify the virus to blame.

Practically all viruses can be responsible for the occurrence of a pericarditis. Very often, the symptoms of the pericarditis are characteristic but the absence of a liquid effusion in the pericardium is often noted during the implementation of the cardiac echography.

This type of a pericarditis rarely evolves toward serious complications.

2 - The pericarditis due to tuberculosis (5% of the pericarditis causes)

Like the pulmonary tuberculosis, the pericarditis occurs during a resurgence of a first tuberculosis. Hence, it is more frequent in the transplanted and the immuno-depressed fragile subjects.

The discovery of the Mycobacterium tuberculosis makes the diagnosis.

3 - The pericarditis due to a developed cancer close to the heart (5% of the cases)

It is secondary to a vicinity cancer (bronchogenic cancer, breast cancer, oesophageal cancer...), a blood cancer (lymphoma, myeloma), and more seldom to a remote cancer (digestive, renal, gynaecological cancer...), and unusually to an idiopathic cancer of the pericardium.

The effusion of the pericarditis is generally abundant and often recidivates.

4 - The pericarditis due to an illness of the immune system

The most frequent among the illnesses of the immune system is the systematic acute lupus erythematosus disseminatus. The effusion of the pericardium is frequent but most often it does not come with symptoms.

Scleroderma, periarteritis nodosa (PAN) and dermatomyosites also come with a pericarditis.

5 - The pericarditis due to an infection of the pericardium

Sometimes, a bacterium can penetrate into the pericardium and develop thus creating a real infection around the heart.

The activating factors a septicaemia secondary to a remote focus, a lungs infection, a traumatism or a cardiac surgery.

6 - The other more seldom causes

Many other causes can be mentioned: rheumatoid arthritis, rheumatic fever, amylosis, sarcoidosis, pericarditis in the acute phase of a myocardial infarction, post-infarct pericarditis or Dressler’s syndrome of immunological nature, and parasitic pericarditises.

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File last reviewed on dec 18, 2011