Editing Pericarditis

{{Short description|Inflammation of the pericardium}}
{{Infobox medical condition
| name            = Pericarditis
| image           = Pericarditis10.JPG
| caption         = An ECG showing pericarditis, with [[ST elevation]] in multiple leads and slight reciprocal [[ST depression]] in aVR.
| width           = 350px
| field           = [[Cardiology]]
| symptoms        = Sharp [[chest pain]], better sitting up and worse with lying down, [[fever]]<ref name=NIH2012Sym/>
| complications   = [[Cardiac tamponade]], [[myocarditis]], [[constrictive pericarditis]]<ref name=NIH2012Sym/><ref name=HEART2015/>
| onset           = Typically sudden<ref name=NIH2012Sym/>
| duration        = Few days to weeks<ref name=NIH2012Prog/>
| types           =
| causes          = [[Viral infection]], [[tuberculosis]], [[uremic pericarditis]], following a [[myocardial infarction|heart attack]], [[cancer]], [[autoimmune disorder]]s, [[chest trauma]]<ref name=AFP2007/><ref name=NIH2012Ca/>
| risks           =
| diagnosis       = Based on symptoms, [[electrocardiogram]], [[pericardial effusion|fluid around the heart]]<ref name=Im2015/>
| differential    = [[myocardial infarction|Heart attack]]<ref name=NIH2012Sym/>
| prevention      =
| treatment       = [[NSAIDs]], [[colchicine]], [[corticosteroid]]s<ref name=Im2015/>
| medication      =
| prognosis       = Usually good<ref name=Im2015/><ref>{{cite book |last1=Cunha |first1=Burke A. | name-list-style = vanc |title=Antibiotic Essentials |date=2010 |publisher=Jones & Bartlett Publishers |isbn=978-1-4496-1870-4 |page=71 |url=https://books.google.com/books?id=RU7p9EwQ_S0C&pg=PA71 |language=en}}</ref>
| frequency       = 3 per 10,000 per year<ref name=HEART2015/>
| deaths          =
}}

<!-- Definition and symptoms -->
'''Pericarditis''' ({{respell|PER|i-|kar|DYE|tis}}) is [[inflammation]] of the [[pericardium]], the fibrous sac surrounding the [[heart]].<ref name=NIH2012What>{{cite web|title=What Is Pericarditis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/peri|website=National Heart, Lung, and Blood Institute|date=September 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20161002030835/https://www.nhlbi.nih.gov/health/health-topics/topics/peri|archive-date=October 2, 2016}}</ref> Symptoms typically include sudden onset of sharp [[chest pain]], which may also be felt in the shoulders, neck, or back.<ref name="NIH2012Sym" /> The pain is typically less severe when sitting up and more severe when lying down or breathing deeply.<ref name="NIH2012Sym" /> Other symptoms of pericarditis can include [[fever]], [[weakness]], [[palpitations]], and [[shortness of breath]].<ref name=NIH2012Sym/> The onset of symptoms can occasionally be gradual rather than sudden.<ref name=NIH2012What/>

<!-- Cause and diagnosis -->
The cause of pericarditis often remains unknown but is believed to be most often due to a [[viral infection]].<ref name=AFP2007>{{cite journal | vauthors = Tingle LE, Molina D, Calvert CW | title = Acute pericarditis | journal = American Family Physician | volume = 76 | issue = 10 | pages = 1509–14 | date = November 2007 | pmid = 18052017 }}</ref><ref name="NIH2012What" /> Other causes include [[bacterial infection]]s such as [[tuberculosis]], [[uremic pericarditis]], [[heart attack]], [[cancer]], [[autoimmune disorder]]s, and [[chest trauma]].<ref name=AFP2007/><ref name=NIH2012Ca>{{cite web|title=What Causes Pericarditis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/peri/causes|website=National Heart, Lung, and Blood Institute|access-date=28 September 2016|date=September 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20161002035605/https://www.nhlbi.nih.gov/health/health-topics/topics/peri/causes|archive-date=2 October 2016}}</ref> Diagnosis is based on the presence of chest pain, a [[pericardial rub]], specific [[electrocardiogram]] (ECG) changes, and [[pericardial effusion|fluid around the heart]].<ref name=Im2015/> A heart attack may produce similar symptoms to pericarditis.<ref name=NIH2012Sym/>

<!-- Treatment, prognosis, and epidemiology -->
Treatment in most cases is with [[NSAIDs]] and possibly the anti-inflammatory medication [[colchicine]].<ref name=Im2015/> [[Corticosteroid|Steroids]] may be used if these are not appropriate.<ref name=Im2015>{{cite journal | vauthors = Imazio M, Gaita F, LeWinter M | title = Evaluation and Treatment of Pericarditis: A Systematic Review | journal = JAMA | volume = 314 | issue = 14 | pages = 1498–506 | date = October 2015 | pmid = 26461998 | doi = 10.1001/jama.2015.12763 | hdl = 2318/1576078 | hdl-access = free }}</ref> Symptoms usually improve in a few days to weeks but can occasionally last months.<ref name=NIH2012Prog>{{cite web|title=How Is Pericarditis Treated?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/peri/treatment| website = National Heart, Lung, and Blood Institute |access-date=28 September 2016|date=September 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20161002032853/https://www.nhlbi.nih.gov/health/health-topics/topics/peri/treatment|archive-date=2 October 2016}}</ref> Complications can include [[cardiac tamponade]], [[myocarditis]], and [[constrictive pericarditis]].<ref name=NIH2012Sym>{{cite web|title=What Are the Signs and Symptoms of Pericarditis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/peri/signs| website = National Heart, Lung, and Blood Institute |access-date=28 September 2016|date=September 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20161002032323/https://www.nhlbi.nih.gov/health/health-topics/topics/peri/signs|archive-date=2 October 2016}}</ref><ref name=HEART2015>{{cite journal | vauthors = Imazio M, Gaita F | s2cid = 35310104 | title = Diagnosis and treatment of pericarditis | journal = Heart | volume = 101 | issue = 14 | pages = 1159–68 | date = July 2015 | pmid = 25855795 | doi = 10.1136/heartjnl-2014-306362 }}</ref> Pericarditis is an uncommon cause of chest pain.<ref>{{cite journal | vauthors = McConaghy JR, Oza RS | title = Outpatient diagnosis of acute chest pain in adults | journal = American Family Physician | volume = 87 | issue = 3 | pages = 177–82 | date = February 2013 | pmid = 23418761 }}</ref> About 3 per 10,000 people are affected per year.<ref name=HEART2015/> Those most commonly affected are males between the ages of 20 and 50.<ref name=NIH2012Who/> Up to 30% of those affected have more than one episode.<ref name=NIH2012Who>{{cite web|title=Who Is at Risk for Pericarditis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/peri/atrisk| website = National Heart, Lung, and Blood Institute |access-date=28 September 2016|date=September 26, 2012|url-status=live|archive-url=https://web.archive.org/web/20161002014435/https://www.nhlbi.nih.gov/health/health-topics/topics/peri/atrisk|archive-date=2 October 2016}}</ref>
{{TOC limit|3}}

==Signs and symptoms==
Substernal or left [[Precordium|precordial]] [[pleuritic]] [[chest pain]] with radiation to the trapezius ridge (the bottom portion of [[scapula]] on the back) is the characteristic pain of pericarditis. The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and [[supine position]]s) or by inspiration (taking a breath in).<ref name=mk>{{cite book |author=American College of Physicians (ACP) |chapter=Pericardial disease |title=Medical Knowledge Self-Assessment Program (MKSAP-15): Cardiovascular Medicine |isbn=978-1-934465-28-8 |page=64 |chapter-url=http://www.acponline.org/products_services/mksap/15/complete.htm |url-status=live |archive-url=https://web.archive.org/web/20100802163510/http://www.acponline.org/products_services/mksap/15/complete.htm |archive-date=2010-08-02 |year=2009 |publisher=American College of Physicians }}</ref> The pain may resemble that of [[angina]] but differs in that pericarditis pain changes with body position, where heart attack pain is generally constant and pressure-like. Other symptoms of pericarditis may include dry [[cough]], [[fever]], fatigue, and [[anxiety]].{{citation needed|date=February 2021}}

Due to its similarity to the pain of [[myocardial infarction]] (heart attack), pericarditis can be misdiagnosed as a heart attack. Acute myocardial infarction can also cause pericarditis, but the presenting symptoms often differ enough to warrant diagnosis. The following table organizes the clinical presentation of pericarditis differential to myocardial infarction:<ref name=mk />

{| class="wikitable"
! scope="col" | Characteristic
! scope="col" | Pericarditis
! scope="col" | Myocardial infarction
|-
! scope="row" | Pain description
| Sharp, [[pleuritic]], retro-sternal (under the sternum) or left precordial (left chest) pain
| Crushing, pressure-like, heavy pain. Described as "elephant on the chest."
|-
! scope="row" | Radiation
| Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation.
| Pain radiates to the jaw or left arm, or does not radiate.
|-
! scope="row" | Exertion
| Does not change the pain
| Can increase the pain
|-
! scope="row" | Position
| Pain is worse in the [[supine position]] or upon inspiration (breathing in)
| Not positional
|-
! scope="row" | Onset/duration
| Sudden pain, that lasts for hours or sometimes days before a person comes to the ER
| Sudden or chronically worsening pain that can come and go in [[paroxysm]]s or it can last for hours before the person decides to come to the ER
|}

===Physical examinations===
The classic [[medical sign|sign]] of pericarditis is a [[pericardial rub|friction rub]] [[Auscultation|heard with a stethoscope]] on the cardiovascular examination, usually on the lower left [[Sternum|sternal border]].<ref name=mk /> Other physical signs include a person in distress, positional chest pain, diaphoresis (excessive sweating); possibility of heart failure in form of pericardial [[Cardiac tamponade|tamponade]] causing [[pulsus paradoxus]], and the [[Beck's triad (cardiology)|Beck's triad]] of [[hypotension|low blood pressure]] (due to decreased [[cardiac output]]), distant (muffled) heart sounds, and [[Jugular vein distension|distension of the jugular vein]] (JVD). The presence of a triphasic pericardial friction rub on auscultation. A bedside electrocardiogram (ECG) shows widespread concave ST elevation and PR depression throughout most of the limb and precordial leads.

===Complications===
Pericarditis can progress to [[pericardial effusion]] and eventually [[cardiac tamponade]]. This can be seen in people who are experiencing the classic signs of pericarditis but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, [[pulsus paradoxus]] (decrease of at least 10 mmHg of the systolic blood pressure upon [[Inhalation|inspiration]]), low blood pressure (due to decreased [[cardiac index]]), (jugular vein distention from right sided [[heart failure]] and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid.{{citation needed|date=February 2021}}

In such cases of cardiac tamponade, [[Electrocardiogram|EKG]] or [[Holter monitor]] will then depict [[electrical alternans]] indicating wobbling of the heart in the fluid filled pericardium, and the [[capillary refill]] might decrease, as well as severe vascular collapse and [[altered mental status]] due to hypoperfusion of body organs by a heart that can not pump out blood effectively.{{citation needed|date=February 2021}}

The diagnosis of tamponade can be confirmed with [[Transthoracic echocardiogram|trans-thoracic echocardiography]] (TTE), which should show a large pericardial effusion and diastolic collapse of the right ventricle and right atrium. [[Chest X-ray]] usually shows an enlarged cardiac silhouette ("water bottle" appearance) and clear lungs. Pulmonary congestion is typically not seen because equalization of diastolic pressures constrains the pulmonary capillary wedge pressure to the intra-pericardial pressure (and all other diastolic pressures).{{citation needed|date=February 2021}}

==Causes==
[[File:Pericarditis.jpg|thumb|Figure A shows the location of the heart and a normal heart and pericardium (the sac surrounding the heart). The inset image is an enlarged cross-section of the pericardium that shows its two layers of tissue and the fluid between the layers.<br />Figure B shows the heart with pericarditis. The inset image is an enlarged cross-section that shows the inflamed and thickened layers of the pericardium.<ref name="NIH old page">{{cite web|title=Pericarditis|url=http://www.nhlbi.nih.gov/health/health-topics/topics/peri/printall-index.html| website = National Heart, Lung, and Blood Institute .nih.gov|access-date=5 August 2014|archive-url=https://web.archive.org/web/20140808120716/http://www.nhlbi.nih.gov/health/health-topics/topics/peri/printall-index.html|archive-date=8 August 2014}}</ref><!-- PD source -->]]

===Infectious===
Pericarditis may be caused by [[virus|viral]], [[bacteria]]l, or [[fungus|fungal]] infection.

In the developing world the bacterial disease [[tuberculosis]] is a common cause, whereas in the developed world viruses are believed to be the cause of about 85% of cases.<ref name=Im2015/> Viral causes include [[coxsackievirus]], [[herpesvirus]], [[mumps virus]], and [[HIV]] among others.<ref name=AFP2007/> Also observed by [[James Blachly]], [[Strep Throat]] can also cause pericarditis due to the heart sac filling up.

[[Pneumococcus]] or [[tuberculous pericarditis]] are the most common bacterial forms. [[Anaerobic bacteria]] can also be a rare cause.<ref>{{cite journal | vauthors = Brook I | title = Pericarditis caused by anaerobic bacteria | journal = International Journal of Antimicrobial Agents | volume = 33 | issue = 4 | pages = 297–300 | date = April 2009 | pmid = 18789852 | doi = 10.1016/j.ijantimicag.2008.06.033 }}</ref> Fungal pericarditis is usually due to [[histoplasmosis]], or in [[immunocompromise]]d hosts [[Aspergillus]], [[Candida (genus)|Candida]], and [[Coccidioides]].{{citation needed|date=March 2014}} The most common cause of pericarditis worldwide is infectious pericarditis with tuberculosis.{{citation needed|date=March 2014}}

===Other===
* [[Idiopathic]]: No identifiable cause found after routine testing.<ref name=AFP2007/>
* [[Autoimmune disease]]: [[systemic lupus erythematosus]], [[rheumatic fever]],<ref name=AFP2007/> [[IgG4-related disease]]<ref>{{cite journal | vauthors = Ibe T, Nakamura T, Taniguchi Y, Momomura S | title = IgG4-related effusive constrictive pericarditis | journal = European Heart Journal: Cardiovascular Imaging | volume = 17 | issue = 6 | page = 707 | date = June 2016 | pmid = 27044912 | doi = 10.1093/ehjci/jew056 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Atallah PC, Kassier A, Powers S | title = IgG4-related disease with effusive-constrictive pericarditis, tamponade, and hepatopathy: a novel triad | journal = International Journal of Cardiology | volume = 176 | issue = 2 | pages = 516–8 | date = September 2014 | pmid = 25062559 | doi = 10.1016/j.ijcard.2014.07.046 | url = http://www.internationaljournalofcardiology.com/article/S0167-5273(14)01238-8/abstract | url-access = subscription }}</ref>
* [[Myocardial infarction]]
** [[Dressler's syndrome]]<ref name=AFP2007/>
** Peri-Myocardial Infarction Pericarditis<ref>
{{cite news
|url =https://edelweisspublications.com/articles/2/450/Peri-Myocardial-Infarction-Pericarditis:-Current-Concepts
|access-date = 15 February 2022
|title = Peri-Myocardial Infarction Pericarditis: Current Concepts
|author=Gharacholou S Michael |author2=Vaca-Cartagena F Bryan |author3=Parikh P Pragnesh |author4=Pollak M Peter |author5=Bruce J Charles
|newspaper = Edelweiss Publications Inc
}}</ref>
* [[Physical trauma|Trauma]] to the heart<ref name=AFP2007/>
* [[Uremia]] ([[uremic pericarditis]])<ref name=AFP2007/>
* [[Cancer]]<ref name=AFP2007/>
* [[Adverse drug reaction|Side effect]] of some [[medications]], e.g. [[isoniazid]], [[cyclosporine]], [[hydralazine]], [[warfarin]], and [[heparin]]
* [[Radiation]] induced<ref name=AFP2007/>
* [[Aortic dissection]]<ref name=AFP2007/>
* [[Postpericardiotomy syndrome]]—such as after [[CABG]] surgery<ref name=AFP2007/>
* [[Vaccines]]-such as [[smallpox]]<ref name=josephpage376/><ref>{{cite news |url=https://academic.oup.com/cid/article/46/Supplement_3/S242/575828 |title= Myocarditis, Pericarditis, and Dilated Cardiomyopathy after Smallpox Vaccination among Civilians in the United States, January–October 2003 |date=15 March 2008 |access-date=22 January 2022}}</ref> and [[COVID-19 vaccine|COVID-19 Vaccines]]<ref>{{cite news|title=Myocarditis and Pericarditis After mRNA COVID-19 Vaccination|url=https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html|access-date=22 January 2022}}</ref> in rare yet documented instances.

In August 2024, a team of Japanese researchers analyzed the data stored on the Japanese Adverse Drug Event Report database and investigated the link between Covid-19 vaccination and [[myocarditis]] and pericarditis. They found an association between mRNA injections and the heart diseases at statistically significant levels: the reporting odds ratio were 15.64(BNT162b2) and 54.23(mRNA-1273) for myocarditis, and 15.78(BNT162b2) and 27.03(mRNA-1273) for pericarditis.<ref> {{cite journal 
| title = SARS-CoV-2 mRNA vaccine-related myocarditis and pericarditis: An analysis of the Japanese Adverse Drug Event Report database
| journal = Journal of Infection and Chemotherapy
| date = Aug 2024
| vauthors = ((Takada, K.)) 
}}
</ref>

==Diagnosis==

[[File:PericarditisMyocarditis.jpg|thumb|upright=1.5|Diffuse ST elevation in a young male due to myocarditis / pericarditis]]
[[File:PericarditisECG.JPG|thumb|upright=1.5|An ECG showing pericarditis. Note the [[ST elevation]] in multiple leads with slight reciprocal [[ST depression]] in aVR.]]

The preferred initial diagnostic testing is the ECG, which may demonstrate a 12-lead [[electrocardiogram]] with diffuse, non-specific, concave ("saddle-shaped"), ST-segment elevations in all leads except aVR and V1<ref name=mk /> and PR-segment depression possible in any lead ''except aVR'';<ref name=mk /> sinus tachycardia, and low-voltage QRS complexes can also be seen if there is subsymptomatic levels of pericardial effusion. The PR depression is often seen early in the process as the thin atria are affected more easily than the ventricles by the inflammatory process of the pericardium.{{citation needed|date=February 2021}}

Since the mid-19th century, [[retrospective diagnosis]] of pericarditis has been made upon the finding of adhesions of the pericardium.<ref>{{Cite journal| first = Austin | last = Flint | name-list-style = vanc |year=1862|title=Lectures on the diagnosis of diseases of the heart: Lecture VIII|journal=American Medical Times: Being a Weekly Series of the New York Journal of Medicine|volume=5|issue=July to December|pages=309–311}}</ref>

When pericarditis is diagnosed clinically, the underlying cause is often never known; it may be discovered in only 16–22 percent of people with acute pericarditis.{{citation needed|date=March 2014}}

===Imaging===
<gallery>
File:PericardialeffusionUS.PNG|Ultrasounds showing a pericardial effusion in someone with pericarditis
File:PericardialeffusionCXR.PNG|A pericardial effusion as seen on CXR in someone with pericarditis
</gallery>

On MRI [[MRI sequence#T1 and T2|T2-weighted spin-echo]] images, inflamed pericardium will show high signal intensity. [[Cardiac magnetic resonance imaging#Late gadolinium enhancement|Late gadolinium contrast]] will show uptake of contrast by the inflamed pericardium. Normal pericardium will not show any contrast enhancement.<ref>{{cite journal | vauthors = Ismail TF | title = Acute pericarditis: Update on diagnosis and management | journal = Clinical Medicine | volume = 20 | issue = 1 | pages = 48–51 | date = January 2020 | pmid = 31941732 | pmc = 6964178 | doi = 10.7861/clinmed.cme.20.1.4 }}</ref>

===Laboratory test===
Laboratory values can show increased blood urea nitrogen ([[Blood urea nitrogen|BUN]]), or increased blood [[Serum creatinine|creatinine]] in cases of [[uremic pericarditis]]. Generally, however, laboratory values are normal, but if there is a concurrent myocardial infarction (heart attack) or great stress to the heart, laboratory values may show increased cardiac markers like [[Troponin]] (I, T), [[CK-MB]], [[Myoglobin]], and [[Lactate dehydrogenase|LDH]]1 (lactase dehydrogenase isotype 1).{{citation needed|date=February 2021}}

===Classification===
Pericarditis can be classified according to the composition of the fluid that accumulates around the heart.<ref>{{cite web | first =  Edward C. | last = Klatt | name-list-style = vanc | url = http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html | title = Cardiovascular Pathology Index Images | work = The Internet Pathology Laboratory for Medical Education | publisher = Florida State University College of Medicine | archive-url = https://web.archive.org/web/20070524224731/http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html | archive-date=2007-05-24 }}</ref>

Types of pericarditis include the following:{{citation needed|date=October 2021}}
* [[serous]]
* [[purulent]]
* [[Uremic pericarditis|fibrinous]]
* [[caseous]]
* [[hemorrhagic]]

====Acute vs. chronic====
Depending on the time of presentation and duration, pericarditis is divided into "acute" and "chronic" forms. [[Acute pericarditis]] is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack (myocardial infarction), as [[Dressler's syndrome]]. Chronic pericarditis however is less common, a form of which is [[constrictive pericarditis]]. The following is the clinical classification of acute vs. chronic:{{citation needed|date=February 2021}}
* ''Clinically'': Acute (<6 weeks), Subacute (6 weeks to 6 months) and Chronic (>6 months)

==Treatment==
The treatment in viral or idiopathic pericarditis is with [[aspirin]],<ref name=mk /> or [[non-steroidal anti-inflammatory drug]]s (NSAIDs such as [[ibuprofen]]).<ref name=AFP2007/> [[Colchicine]] may be added to the above as it decreases the risk of further episodes of pericarditis.<ref name=AFP2007/><ref>{{cite journal | vauthors = Alabed S, Cabello JB, Irving GJ, Qintar M, Burls A | title = Colchicine for pericarditis | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 8 | pages = CD010652 | date = August 2014 | pmid = 25164988 | doi = 10.1002/14651858.CD010652.pub2 | pmc = 10645160 | url = http://openaccess.city.ac.uk/4043/5/Colchicine%20for%20pericarditis.pdf }}</ref> The drug that helps treat the condition that has developed is aspirin. In this case, the patient is experiencing post-myocardial infarction pericarditis (PIP), which is characterized by chest pain, low-grade fever, and specific findings on physical examination and electrocardiogram. Aspirin is the drug of choice for PIP and is usually already prescribed for secondary prevention following a myocardial infarction. Aspirin acts as an anti-inflammatory drug and helps alleviate the symptoms of pericarditis

Severe cases may require one or more of the following:{{citation needed|date=March 2021}}
* [[antibiotic]]s to treat tuberculosis or other bacterial causes
* [[steroid]]s are used in acute pericarditis but are not favoured. [[Prednisolone]] is effective in treating acute viral or idiopathic pericarditis,
* [[pericardiocentesis]] to treat a large pericardial effusion causing tamponade

Recurrent pericarditis resistant to colchicine and anti-inflammatory steroids may benefit from a number of medicines that affect the action of [[interleukin 1]]; they cannot be taken in tablet form. These are [[anakinra]], [[canakinumab]] and [[rilonacept]].<ref>{{cite journal |last1=Tombetti |first1=Enrico |last2=Mulè |first2=Alice |last3=Tamanini |first3=Silvia |last4=Matteucci |first4=Luca |last5=Negro |first5=Enrica |last6=Brucato |first6=Antonio |last7=Carnovale |first7=Carla |title=Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020 |journal=Current Cardiology Reports |date=August 2020 |volume=22 |issue=8 |page=59 |doi=10.1007/s11886-020-01308-y |pmid=32562029 |pmc=7303578}}</ref><ref name=Andreis/> Rilonacept has been specifically approved as an [[orphan drug]] for use in this situation.<ref>{{cite web |last1=Center for Drug Evaluation and Research |title=FDA Approves First Treatment for Disease That Causes Recurrent Inflammation in Sac Surrounding Heart |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-first-treatment-disease-causes-recurrent-inflammation-sac-surrounding-heart |archive-url=https://web.archive.org/web/20210318202443/https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-first-treatment-disease-causes-recurrent-inflammation-sac-surrounding-heart |url-status=dead |archive-date=March 18, 2021 |website=FDA |publisher=U.S. Food and Drug Administration |access-date=19 March 2021 |language=en |date=18 March 2021}}</ref> Immunosuppressive agents, such as [[Azathioprine]] and intravenous immunoglobulins, are a novel therapeutic agent which have been effective in treating and preventing recurrent pericarditis, though research on these therapies is limited.<ref name=Andreis>{{cite journal |last1=Andreis |first1=Alessandro |last2=Imazio |first2=Massimo |last3=Casula |first3=Matteo |last4=Avondo |first4=Stefano |last5=Brucato |first5=Antonio |title=Recurrent pericarditis: an update on diagnosis and management |journal=Internal and Emergency Medicine |date=28 February 2021 |volume=16 |issue=3 |pages=551–558 |doi=10.1007/s11739-021-02639-6 |pmid=33641044 |pmc=7914388}}</ref><ref>{{Cite journal |last1=Marcolongo |first1=Renzo |last2=Russo |first2=Rosario |last3=Laveder |first3=Francesco |last4=Noventa |first4=Franco |last5=Agostini |first5=Carlo |date=November 1995 |title=Immunosuppressive therapy prevents recurrent pericarditis |url=https://linkinghub.elsevier.com/retrieve/pii/0735109795003029 |journal=Journal of the American College of Cardiology |language=en |volume=26 |issue=5 |pages=1276–1279 |doi=10.1016/0735-1097(95)00302-9|pmid=7594043 |s2cid=8236269 |url-access=subscription }}</ref><ref>{{Cite journal |last1=del Fresno |first1=M. Rosa |last2=Peralta |first2=Julio E. |last3=Granados |first3=Miguel Ángel |last4=Enríquez |first4=Eugenia |last5=Domínguez-Pinilla |first5=Nerea |last6=de Inocencio |first6=Jaime |date=2014-11-01 |title=Intravenous Immunoglobulin Therapy for Refractory Recurrent Pericarditis |url=https://publications.aap.org/pediatrics/article/134/5/e1441/75845/Intravenous-Immunoglobulin-Therapy-for-Refractory |journal=Pediatrics |language=en |volume=134 |issue=5 |pages=e1441–e1446 |doi=10.1542/peds.2013-3900 |pmid=25287461 |s2cid=12121925 |issn=0031-4005|url-access=subscription }}</ref><ref>{{Cite journal |last1=Andreis |first1=Alessandro |last2=Imazio |first2=Massimo |last3=Casula |first3=Matteo |last4=Avondo |first4=Stefano |last5=Brucato |first5=Antonio |date=April 2021 |title=Recurrent pericarditis: an update on diagnosis and management |journal=Internal and Emergency Medicine |language=en |volume=16 |issue=3 |pages=551–558 |doi=10.1007/s11739-021-02639-6 |issn=1828-0447 |pmc=7914388 |pmid=33641044}}</ref>

Surgical removal of the pericardium, [[pericardiectomy]], may be used in severe cases and where the pericarditis is causing constriction, impairing cardiac function. It is less effective if the pericarditis is a consequence of trauma, in elderly patients, and if the procedure is done incompletely. It carries a risk of death between 5&nbsp;and 10%.<ref name=Andreis/>

==Epidemiology==
About 30% of people with viral pericarditis or pericarditis of an unknown cause have one or several recurrent episodes.<ref name="Im2015"/>

==See also==
* [[Acute pericarditis]]
* [[Constrictive pericarditis]]
* [[Dressler syndrome]]
* [[Myopericarditis]]
* [[Pericardial effusion]]
* [[Purulent pericarditis]]
* [[Tuberculous pericarditis]]
* [[Uremic pericarditis]]
* [[Viral cardiomyopathy]]

== References ==
{{Reflist|refs=
<ref name="josephpage376">{{cite journal| pmc=6437672 | year=2018 | last1=Kuntz | first1=J. | last2=Crane | first2=B. | last3=Weinmann | first3=S. | last4=Naleway | first4=A. L. | author5=Vaccine Safety Datalink Investigator Team | title=Myocarditis and pericarditis are rare following live viral vaccinations in adults | journal=Vaccine | volume=36 | issue=12 | pages=1524–1527 | doi=10.1016/j.vaccine.2018.02.030 | pmid=29456017 }}</ref>}}

== External links ==
* [https://www.nlm.nih.gov/medlineplus/ency/article/000182.htm Pericarditis&nbsp;— National Library of Medicine]
* [http://www.nhlbi.nih.gov/health/dci/Diseases/peri/peri_whatis.html Pericarditis&nbsp;— National Heart Lung Blood Institute]
{{Medical resources
| DiseasesDB      = 9820
| ICD10           = {{ICD10|I|01|0|i|00}}, {{ICD10|I|09|2|i|05}}, {{ICD10|I|30||i|30}}–{{ICD10|I|32||i|30}}
| ICD9            = {{ICD9|420.0}}, {{ICD9|420.90}}, {{ICD9|420.91}}, {{ICD9|420.99}}, {{ICD9|423.1}}, {{ICD9|423.2}}
| ICDO            =
| OMIM            =
| MedlinePlus     = 000182
| eMedicineSubj   = med
| eMedicineTopic  = 1781
| eMedicine_mult  = {{eMedicine2|emerg|412}}
| MeshID          = D010493
| SNOMED CT       = 3238004
}}

{{Circulatory system pathology}}

[[Category:Pericardial disorders]]
[[Category:Disorders of fascia]]
[[Category:Inflammations]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]
[[Category:Steroid-responsive inflammatory conditions]]