Approach to Pericarditis

Pericarditis is the inflammation of the parietal and visceral layers of the pericardium, presenting with characteristic chest pain, electrocardiographic changes, and a pericardial friction rub. It is the most frequent form of pericardial disease and a common cause of chest pain, particularly affecting males between 20-50 years. The etiology includes viral, bacterial, fungal, and parasitic infections, autoimmune diseases, trauma, and other conditions like uremia and hypothyroidism.
The pathophysiology involves the activation of the inflammatory cascade leading to pericardial effusion, which can range from serous to hemorrhagic in nature. Acute pericarditis is characterized by intense inflammation and effusion, while chronic pericarditis may lead to fibrosis and constrictive pericarditis.
Diagnosis relies on clinical evaluation, typical chest pain, EKG changes, and detection of pericardial effusion via echocardiography. Laboratory tests help rule out other conditions, and imaging techniques like CT and MRI can confirm the diagnosis.
Treatment is generally symptomatic for viral/idiopathic cases, utilizing NSAIDs, colchicine, and sometimes corticosteroids. Purulent pericarditis requires surgical drainage and antibiotics, while tuberculous pericarditis needs specific anti-tuberculosis treatment. Pericardiocentesis is indicated for tamponade, and pericardiectomy for constriction.
The prognosis is typically benign for idiopathic and viral pericarditis, although recurrent episodes can affect the quality of life. Acute pericarditis usually resolves without long-term damage, but complications such as cardiac tamponade and constrictive pericarditis can occur.