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37 - Acute Pericarditis

from Part VI - Clinical Syndromes – Heart and Blood Vessels

Published online by Cambridge University Press:  05 March 2013

Richard A. Martinello
Affiliation:
Yale University School of Medicine
Michael Cappello
Affiliation:
Yale University School of Medicine
David Schlossberg
Affiliation:
Temple University School of Medicine, Philadelphia
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Summary

INTRODUCTION

The pericardium serves to protect the heart from physiologic changes in intracardiac pressure related to respiration and postural change, and it may also serve to augment the mechanical function of the cardiac chambers. The pericardium is composed of a visceral layer that directly adheres to the epicardium and a parietal layer separated by 10 to 35 mL of serous fluid.

EPIDEMIOLOGY AND ETIOLOGIC AGENTS

Both infectious and noninfectious processes have been identified as causes of pericarditis (inflammation of the pericardium). Most cases are due to viral pathogens and are self-limited, and the specific pathogen remains unidentified. In one series, pericarditis was diagnosed in 5% of adults presenting for emergency care due to chest pain that was not associated with myocardial infarction. Because the majority of cases of acute pericarditis are caused by viruses, most patients present in the spring and summer months, overlapping with the peak prevalence of enteroviruses. During the winter months, influenza virus is a frequent cause of pericarditis, whereas pericarditis due to bacterial or atypical pathogens occurs throughout the year.

In areas of the world where the incidence of infection with M. tuberculosis remains high, tuberculosis is responsible for more than 50% of cases of acute pericarditis. Tuberculosis should be considered in persons who have spent significant time in endemic countries, including international adoptees, immigrants, and refugees.

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Publisher: Cambridge University Press
Print publication year: 2008

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