Pericarditis: Understanding the Causes and Risk Factors

Pericarditis, an inflammation of the pericardium—the thin, sac-like membrane surrounding the heart—can arise from a variety of underlying conditions. In most cases, pericardial disease develops as a secondary complication of another illness, or it may present as the primary symptom with a clear identifiable cause. However, in some instances, determining the exact cause remains challenging, even after thorough clinical and pathological evaluation.

Common Causes of Pericarditis

Medical science has identified several key causes of pericarditis, which can be broadly categorized into infectious and non-infectious types. Understanding these categories helps in diagnosing and treating the condition more effectively.

1. Idiopathic (Non-Specific) Pericarditis

Idiopathic pericarditis refers to cases where there is clear clinical or pathological evidence of inflammation, but the specific cause cannot be identified. This type is more common than previously thought and often resolves on its own or with minimal treatment.

2. Infectious Pericarditis

Infectious pericarditis is caused by various pathogens. These include:

• Bacterial infections – Such as those caused by Streptococcus, Staphylococcus, pneumococcal bacteria, and Mycobacterium tuberculosis, which can lead to purulent or tuberculous pericarditis.
• Viral infections – Common culprits include Coxsackievirus, Echovirus, influenza virus, and adenoviruses. Viral pericarditis is often associated with seasonal outbreaks and may follow a mild upper respiratory infection.
• Fungal infections – Less common but potentially severe, fungal pericarditis may result from organisms such as Histoplasma capsulatum, Coccidioides, Candida, and Actinomyces. These are more frequently seen in immunocompromised individuals.
• Parasitic and other infections – Rare causes include parasites like Entamoeba histolytica, Toxoplasma gondii, tapeworms, and infections caused by Chlamydia species.

3. Non-Infectious Pericarditis

Non-infectious forms of pericarditis are also quite prevalent and may be linked to a variety of systemic or localized conditions, including:

• Cardiovascular diseases – Such as myocardial infarction (heart attack), cardiac surgery, or trauma to the chest area.
• Neoplastic diseases – Cancers that metastasize to the pericardium, especially lung, breast, and lymphatic cancers.
• Uremic pericarditis – A complication of chronic kidney disease where toxins build up in the blood and cause inflammation.
• Autoimmune disorders – Conditions like systemic lupus erythematosus (SLE), rheumatoid arthritis, and scleroderma can trigger immune-mediated pericardial inflammation.
• Endocrine or metabolic disorders – Including hypothyroidism and severe lipid abnormalities.
• Physical trauma or radiation – Chest injuries or radiation therapy to the chest can lead to pericardial inflammation.
• Medication-induced pericarditis – Rarely, certain drugs, such as hydralazine, procainamide, and anticoagulants, may trigger pericardial reactions.

Conclusion

Pericarditis can be a complex condition with multiple potential causes. Accurate diagnosis often requires a detailed medical history, physical examination, and a range of diagnostic tests. Identifying the underlying cause is crucial for effective treatment and long-term management. If you experience symptoms such as chest pain, shortness of breath, or palpitations, it's important to seek medical attention promptly.