Epidemiology
Acute pericarditis is more common in adults (typically between 20 to 50 years old) and in men.[15] It is the most common disease of the pericardium encountered in clinical practice. The true incidence and prevalence are unknown and there are a large number of undiagnosed cases. Pericarditis may account for up to 5% of presentations to emergency departments for chest pain and up to 0.1% of hospital admissions.[16][17][18]
Risk factors
Acute pericarditis is described more commonly in men, particularly in the viral form in which there is a 3:1 male-to-female ratio.[15]
The disorder is more commonly described in adults ages 20 to 50 years.[15]
Two forms of pericarditis following MI exist: "early" (pericarditis epistenocardica) and "delayed" (Dressler syndrome).[28][29] The early form is caused by local inflammation at the epicardial MI border with direct exudation. It occurs in 5% to 20% of transmural MIs, but is not often recognized clinically. The delayed form occurs from 1 week to several months postinfarction and does not require a transmural infarction. Its incidence is 0.5% to 5% (and <0.5% in patients treated with thrombolytics). The incidence of pericarditis following transmural MI has declined since the use of thrombolytics and myocardial revascularization.
Postpericardiotomy syndrome has been reported in up to 20% of cases 4 weeks after coronary artery bypass grafting. It develops days to months postoperatively. Compared with the postinfarction syndrome, there is a greater antiheart antibody response (antisarcolemmal and antifibrillatory) with higher release of antigens.[1][13]
Viral pericarditis is the most common pericardial infection.[1][13] The inflammation is due to direct viral attack and/or an immune response (antiviral or anticardiac). Onset is frequently postviral, with no evidence of virus present in the pericardium.
Purulent pericarditis caused by bacterial pathogens occurs in 5% of cases. Pericardial infection can occur by hematogenous spread or by direct extension from adjacent organs, notably the lungs and/or pleural space.
In developed countries, 4% of acute pericarditis cases are due to Mycobacterium tuberculosis.[30]
Two forms exist: uremic pericarditis and dialysis-associated pericarditis. Uremic pericarditis is reported in 6% to 10% of patients with acute or chronic renal failure prior or shortly after institution of dialysis. The likelihood of pericarditis increases with the severity of azotemia (BUN >60 mg/dL).[1]
Dialysis-associated pericarditis is reported in up to 13% of patients receiving chronic hemodialysis. It is occasionally seen in patients on peritoneal dialysis who have not been adequately dialyzed. Most patients respond to intensive dialysis within 1 to 2 weeks.
Pericarditis is commonly associated with diseases such as rheumatoid arthritis and lupus but may not be clinically apparent.[1]
Occurs weeks to months post-event.
Radiation therapy-associated acute exudative pericarditis is rare. Delayed acute pericarditis is more common, and occurs weeks after radiation therapy. It is generally manifested as an asymptomatic pericardial effusion or symptomatic pericarditis. Delayed chronic pericarditis may appear weeks to years after radiation therapy and cause constrictive pericarditis.[31]
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