Acute pericarditis is a syndrome caused by acute inflammation of the visceral and parietal layers of the pericardium. The most common causes of acute pericarditis include the following:
1. Idiopathic or Non-Specific Causes
A significant number of acute pericarditis cases are classified as idiopathic, meaning no specific cause can be identified. These are often presumed to be post-viral or non-specific inflammatory reactions. Despite the lack of a clear trigger, these cases still require proper medical evaluation and monitoring.
2. Infectious Agents
Infections are a major contributor to the development of acute pericarditis. Viruses such as coxsackievirus, echovirus, and adenovirus are among the most common infectious causes. Bacterial infections, particularly those leading to purulent or suppurative pericarditis, can also be responsible. Tuberculosis remains a significant cause in regions where it is endemic, and fungal infections may also lead to pericardial inflammation in immunocompromised individuals.
3. Autoimmune and Inflammatory Disorders
Conditions such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and other autoimmune diseases can trigger pericardial inflammation. In these cases, the body's immune system mistakenly attacks the pericardium, leading to pain and fluid accumulation.
4. Malignancy and Trauma
Cancer, especially metastatic tumors that spread to the pericardium, is increasingly recognized as a cause of acute pericarditis. Additionally, trauma to the chest, whether blunt or penetrating, can result in inflammation of the pericardial sac. Post-cardiac injury syndrome is another related condition that can occur after heart surgery or myocardial infarction.
5. Other Secondary Causes
Other less common but notable causes include myocardial infarction, radiation therapy to the chest, and certain medications that may trigger an inflammatory response. Renal failure and end-stage liver disease have also been associated with pericardial involvement.
Treatment and Prognosis
The management of acute pericarditis typically involves a combination of pharmacological therapy and, in severe cases, surgical intervention. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin are commonly prescribed to reduce inflammation and relieve pain. Colchicine is often used as an adjunct therapy to prevent recurrence. In cases of bacterial or tuberculous pericarditis, antibiotics or antituberculous medications are essential. If there is significant fluid buildup or cardiac tamponade, pericardiocentesis or surgical drainage may be necessary.
Supportive Care and Recovery
Rest and avoidance of strenuous activity are generally advised during the acute phase. Patients are encouraged to monitor symptoms closely and seek medical attention if they experience worsening chest pain or shortness of breath. With appropriate treatment, most patients recover fully, although some may experience recurrent episodes that require long-term management.