Section 1 Pericarditis

**3**

**Chapter 1**

Disease

**1. Introduction**

**2. Pericarditis**

**2.1 Acute pericarditis**

*Takashi Murashita*

sis, and the treatment for pericardial diseases.

tomography or magnetic resonance imaging.

is recommended for low-risk patients.

Prologue: Introduction to

Advanced Concepts in Pericardial

Pericardial diseases are common in clinical practice and include a variety of pathologies such as pericarditis (acute, subacute, chronic, and recurrent), pericardial effusion, cardiac tamponade, constrictive pericarditis, and pericardial masses [1, 2]. The etiology of pericardial diseases is classified into infectious, autoimmune, post-myocardial infarction, and autoreactive causes. When etiology is not apparent, it is classified as idiopathic. Multimodality imaging is an essential approach for a modern and comprehensive diagnostic evaluation [3]. The goal of this text is to highlight the current concepts in the clinical characteristics, presentation, diagno-

Acute pericarditis can be diagnosed with at least two of the four following criteria: (1) pericarditic chest pain, (2) pericardial rubs, (3) new widespread ST elevation or PR depression on electrocardiogram, and (4) pericardial effusion (new or worsening). The additional supporting findings include (1) elevation of inflammation markers (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and (2) evidence of pericardial inflammation shown by computed

In developing countries, tuberculosis is the leading cause of pericarditis, and it is often associated with HIV infection. In developed countries, more than 80% of the

In terms of diagnosis of suspected acute pericarditis, electrocardiogram, transthoracic echocardiogram, chest X-ray, and assessment of inflammation markers and

Regarding treatment, aspirin or NSAIDs are recommended as first-line therapy with gastroprotection. Colchicine is also recommended as first-line therapy as an

Predictors of poor prognosis for acute pericarditis include (1) fever >38°C, (2) subacute onset, (3) large pericardial effusion, (4) cardiac tamponade, and (5) lack of response to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) after at least 1 week of therapy. If the patients are categorized in high risk (at least one risk factor of above), hospital admission is recommended. Outpatient management

cases are idiopathic, and the cause is often presumed as viral infection [2].

myocardial injury are recommended as a class I indication [1].
