Pericarditis

Obtain urgent transthoracic echocardiography when pericarditis is accompanied by hypotension, tachycardia, elevated jugular venous pressure, pulsus paradoxus, syncope, progressive dyspnea, or a suspected moderate-to-large effusion. Tamponade results from pericardial fluid accumulation that impairs diastolic cardiac filling; the immediate management pathway is drainage rather than escalation of outpatient anti-inflammatory therapy. BMJ+1BMJHaemorrhagic Mycobacterium avium complex pericarditis ...ScienceDirectManagement of Acute and Recurrent Pericarditis: JACC State-of-the ...

Admit or expedite cardiology evaluation when the presentation raises concern for purulent, tuberculous, neoplastic, or systemic inflammatory pericarditis, because these etiologies change the role of pericardial fluid analysis, biopsy, antimicrobial or oncologic treatment, and prognosis. Early echocardiography and a low threshold for diagnostic pericardiocentesis are particularly important when septic pericarditis is possible. BMJ+2BMJSystematic review of culture-confirmed septic pericarditis in systemic ...PubMedDiagnostic issues in the clinical management of pericarditis - PubMedESCSecondary pericarditis: from a suspect to the management

Use the initial history to direct this branch: recent cardiac surgery, percutaneous cardiac intervention, radiation exposure, acute myocardial infarction, advanced kidney failure, known cancer, tuberculosis exposure or epidemiologic risk, and systemic autoimmune features each increase the likelihood of secondary pericarditis. The Lancet+1The LancetPericarditis - The LancetESCSecondary pericarditis: from a suspect to the management

For a definite clinical diagnosis, use a compatible presentation of chest pain and/or dyspnea plus more than one additional criterion: pericardial friction rub; PR depression and/or diffuse ST-segment elevation on ECG; elevated C-reactive protein; new or worsening pericardial effusion; or pericardial edema and/or late gadolinium enhancement on cardiac magnetic resonance imaging. A compatible presentation with only one additional criterion supports possible rather than definite pericarditis; symptoms without an additional criterion make the diagnosis unlikely. ScienceDirectScienceDirectRecurrent pericarditis in children: Clinical and therapeutic differences from adults

At presentation, obtain ECG, CRP, and transthoracic echocardiography to document electrical, inflammatory, and effusion evidence and to assess for hemodynamic consequences. ECG and imaging abnormalities, inflammatory biomarkers, a friction rub, and pericardial fluid or inflammation on echo, CT, or MRI are all used as objective evidence in contemporary pericarditis assessment. BMJ+1BMJArtificial intelligence based multimodal fusion of electronic medical ...cdn clinicaltrials[PDF] MYocarditis and/or pericarditis following mRNA COVID-19 ...

Use cardiac MRI when the diagnosis remains uncertain after clinical evaluation, ECG, inflammatory biomarkers, and echocardiography, or when recurrent symptoms require evidence of ongoing inflammation before intensifying immunomodulatory treatment. Pericardial delayed enhancement is described as the most sensitive diagnostic method for acute pericarditis, while pericardial edema or late gadolinium enhancement supports active disease. ScienceDirect+1ScienceDirectRecurrent pericarditis in children: Clinical and therapeutic differences from adultsWileyPharmacotherapy Update of Acute Idiopathic Pericarditis

Measure cardiac troponin when myocardial involvement is clinically plausible. Elevated myocardial biomarkers, new arrhythmia on ECG or telemetry, echocardiographic abnormalities, and cardiac MRI abnormalities are features used to identify myocarditis in patients with suspected myopericarditis; their presence should shift assessment beyond isolated pericardial disease. Wiley+1WileyMyopericarditis and Pericardial Effusion as the Initial Presentation of ...cdn clinicaltrials[PDF] MYocarditis and/or pericarditis following mRNA COVID-19 ...

In an uncomplicated first episode without epidemiologic, historical, clinical, or echocardiographic clues to a secondary cause, extensive etiologic testing usually does not alter management. Most cases remain idiopathic or presumed viral even after broad testing, and identifying a causative virus is generally futile because it does not change treatment. PubMed+1PubMedDiagnostic issues in the clinical management of pericarditis - PubMedESCSecondary pericarditis: from a suspect to the management

Escalate to a directed search for tuberculosis, purulent infection, malignancy, or systemic inflammatory disease when the presentation is atypical, severe, recurrent, or accompanied by a compatible exposure history, cancer, systemic features, or concerning effusion. The diagnostic objective is to identify conditions in which antimicrobials, cancer-directed therapy, renal replacement optimization, cessation of an offending drug, or systemic immunomodulation may be required. PubMed+2PubMedDiagnostic issues in the clinical management of pericarditis - PubMedESCSecondary pericarditis: from a suspect to the managementPubMedDrug-Induced Lupus Erythematosus - StatPearls - NCBI Bookshelf

In patients with arthralgia, myalgia, fever, rash, constitutional symptoms, or serositis and prolonged exposure to a potential culprit medication, review the drug timeline and evaluate for drug-induced lupus. Antinuclear antibodies and antihistone antibodies commonly support the diagnosis; stopping the responsible medication generally leads to symptom resolution. PubMedPubMedDrug-Induced Lupus Erythematosus - StatPearls - NCBI Bookshelf

Anti-inflammatory drugs are the mainstay of treatment for acute and recurrent pericarditis. For recurrent disease, prolonged NSAID therapy is generally used, and colchicine may be added to NSAID therapy or used as monotherapy when NSAID treatment is unsuitable. ScienceDirect+1ScienceDirectManagement of Acute and Recurrent Pericarditis: JACC State-of-the ...jtcvsJournal of the American Society of Echocardiography

For acute pericarditis, colchicine has randomized-trial evidence of effectiveness when added to conventional anti-inflammatory treatment. A cited regimen is colchicine 1 mg/day for 3 months, with or without a 2-mg loading dose; the trial literature also describes guideline-era doses of 2 mg/day for 1 to 2 days as loading treatment. Select dose and loading strategy cautiously rather than defaulting to loading in every patient. NEJM+1NEJMA Randomized Trial of Colchicine for Acute PericarditisScienceDirectAcute Pericarditis - an overview | ScienceDirect Topics

Before prescribing colchicine, review renal, hepatic, gastrointestinal, hematologic, and cardiac comorbidity and review interacting medications. Reported adverse effects include diarrhea, nausea, abdominal pain, elevated transaminases, alopecia, and less commonly bone marrow suppression, hepatotoxicity, and myotoxicity; severe renal, gastrointestinal, hepatic, or cardiac disorders and blood dyscrasias are listed contraindications in the cited review. ScienceDirectScienceDirectAcute Pericarditis - an overview | ScienceDirect Topics

In recurrent disease, distinguish persistent inflammation from noninflammatory chest pain before extending or escalating therapy. Reassess symptoms, CRP, ECG, echocardiography, and cardiac MRI when needed; MRI evidence of active pericardial edema or late gadolinium enhancement supports an inflammatory target for treatment. ScienceDirect+2ScienceDirectRecurrent pericarditis in children: Clinical and therapeutic differences from adultsWileyPharmacotherapy Update of Acute Idiopathic PericarditisWileyRecent advances in multimodality imaging‐guided therapy in ...

Consider effusive-constrictive pericarditis when clinical hemodynamic compromise persists in the setting of pericardial fluid because the visceral pericardium can continue to compress the heart despite the effusion. This phenotype requires imaging-based hemodynamic assessment and should not be managed solely by repeated empiric anti-inflammatory courses. acpjournals+1acpjournalsEffusive Constrictive Pericarditis in the Era of COVID-19ScienceDirectPericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging

Evaluate suspected constrictive pericarditis with echocardiography and complementary cardiac CT or MRI when anatomy, inflammation, and constrictive physiology remain uncertain. Multimodality imaging is specifically relevant for recurrent, transient constrictive, and effusive-constrictive pericarditis and helps distinguish potentially inflammatory disease from chronic or irreversible constriction. ScienceDirect+2ScienceDirectPericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac ImagingWileyConstrictive Pericarditis as a Rare Manifestation of Graft‐Versus ...WileyRecent advances in multimodality imaging‐guided therapy in ...

For chronic or irreversible constrictive pericarditis, and for refractory recurrent pericarditis despite optimal medical therapy, refer for multidisciplinary pericardiectomy assessment. When surgery is appropriate, radical pericardiectomy on cardiopulmonary bypass is preferred if feasible, and procedures should be performed at high-volume centers with appropriate expertise. ScienceDirectScienceDirectPericardial Diseases: International Position Statement on New Concepts and Advances in Multimodality Cardiac Imaging

Follow patients according to their initial objective abnormalities. A structured approach includes repeat CRP and cardiac biomarkers and repeating ECG, Holter monitoring, echocardiography, or MRI when the corresponding baseline study was abnormal; longitudinal visits at 3 months, 12 months, and annually are used in a myocarditis/pericarditis follow-up protocol. cdn clinicaltrialscdn clinicaltrials[PDF] MYocarditis and/or pericarditis following mRNA COVID-19 ...