Acute pericarditis

Most patients with severe acute pericarditis should be hospitalized for complete diagnosis and observation for complications, particularly effusion and tamponade. Therapy should be directed at a specific inciting etiologic agent, if identified. In all patients, anti-inflammatory and symptomatic treatment should aim at alleviating pain, fever, and malaise, using nonsteroidal anti-inflammatory drugs (NSAIDs) as the mainstays. Choice of treatment should be individualized, but indomethacin should be avoided in adults, if possible, because of its deleterious effect on coronary flow. Colchicine added to NSAIDs or as monotherapy is effective both for the initial attack and to prevent recurrences. Corticosteroids should be used only as a last resort (eg, for severe illness resistant to NSAIDs) or to treat specific inciting illnesses.     

Acute pericarditis

Acute pericarditis may be of viral or idiopathic origin, may be induced by certain drugs, may occur as a consequence of thoracic surgery, may result from infection by bacteria or other organisms, or may be associated with noninfectious systemic disease. In some instances, pericarditis may be detected quickly, and in other cases it may not be recognized until late. This article discusses clinical findings, clinical course, and treatment of acute pericarditis. In addition, diagnosis and treatment of pericardial effusion are presented.     

Acute nonspecific pericarditis

In order to learn the natural history of nonspecific acute pericarditis in our environment, we studied retrospectively 50 patients seen at The Instituto Nacional de Cardiología Ignacio Chávez, between 1972-1985. The clinical history, electrocardiogram, chest x ray, laboratory findings, as well as the outpatient follow-up were analyzed. There was a history of a respiratory or gastrointestinal infection, probably viral in origin, in almost half of the cases (46%). Chest pain was present in 96% of the patients and was the most common symptom. In only half of the patients a pericardial friction rub was heard. A typical S-T elevation was found in 90% of the electrocardiograms. Arrhythmias and conduction disorders were unusual. The echocardiogram showed a pericardial effusion in seven patients and six had a pleural effusion. Only one patient developed signs of cardiac tamponade. None of the patients in this study developed a chronic constrictive pericarditis and there were no deaths. Before or after hospitalization, 14 patients (28%) had multiple episodes of chest pain suggestive of recurrent pericarditis. This study shows that nonspecific acute pericarditis seems to be a self-limited illness with a good prognosis, few recurrences and practically no complications.     

Acute suppurative amebic pericarditis

A 33 year old mulatto man presented with acute pericarditis and severe cardiac tamponade. Trophozoites of Entamoeba histolytica were found in the “anchovy sauce” pus obtained by pericardiocentesis. A large abscess in the left lobe of the liver with extension into the pericardial cavity was revealed by X-ray study after the injection of 75 percent Hypaque into the pericardial cavity. Clinical improvement occurred after treatment with chloroquine, metronidazole and emetine hydrochloride. Forty-five days after discharge the patient was readmitted with signs of constrictive pericarditis, and this lesion was confirmed by cardiac catheterization studies.     

Acute pericarditis after dengue fever

A 63-year-old woman was admitted for acute chest pain and asthenia worsening for one week. Clinical examination was normal. ECG revealed widespread T waves depression. Echocardiography, cardiac MR-scan, biological examinations and coronary angiogram were normal except positive dengue fever serologies. She had suffered from dengue fever recently. Clinical and ECG outcomes were good under treatment. Cardiac complications are scarce in case of dengue fever. In this case report, clinical and especially ECG presentation are typical of acute pericarditis. This pericarditis is due to dengue fever.     

Acute pericarditis with transient constriction

Transient constrictive pericarditis is a rare entity. It is characterized by clinical and echocardiographic features similar to constrictive pericarditis, but is distinguished by its transient nature. This feature is important to recognize for avoiding unnecessary pericardectomy. The case of a patient who presented with acute myopericarditis and typical echocardiographic features of constriction is described. Within weeks, all signs of constriction disappeared spontaneously.