Pericarditis natural history


 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview
Pericarditis can lead to development of pericardial effusion, pericardial tamponade and constrictive pericarditis. Pericardial tamponade or compression of the heart by fluid in the pericardial sac reduces the ability of the heart to pump blood and is a medical emergency requiring urgent pericardiocentesis or a pericardial window. The prognosis depends on the complications of pericardits, the underlying etiology, and the associated co-morbidites. Pericarditis secondary to malignancy, MI, autoimmune disease and renal failure carries a poor prognosis.

Complications
The prognosis associated with pericarditis depends on the underlying cause and associated condition(s).

Click on the blue links below to read more about specific complications of pericarditis:

Pericardial Effusion
Many forms of pericarditis can be complicated by significant fluid buildup around the heart, a condition known as a pericardial effusion.

Pericardial Tamponade
If the fluid accumulates too rapidly or is too large, then cardiac tamponade, a condition in which the heart is compressed by the fluid and cannot pump enough blood forward may occur. Cardiac tamponade may require urgent intervention including pericardiocentesis or a pericardial window. This complication is more common in patients with specific underlying etiologies such as malignancy, tuberculosis, or purulent pericarditis and rarely occurs in idiopathic pericarditis.

Constrictive Pericarditis
If scarring of the sac around the heart (the pericardium) occurs, then this is called constrictive pericarditis which may require surgical stripping of the scar (pericardiectomy).

Idiopathic Pericarditis
Idiopathic pericarditis is often self-limited and most patients recover in 2 weeks to 3 months. Idiopathic or viral pericarditis is associated with a favorable long-term prognosis with few developing recurrences. Approximately 15-30% of patients with idiopathic acute pericarditis who are not treated with colchicine will develop recurrent pericarditis.

Post MI Pericarditis or Dressler's Syndrome
Post MI pericarditis is usually associated with larger infarcts, and therefore these patients have a poorer long term prognosis.

Tuberculous Pericarditis
The mortality rate associated with tuberculous pericarditis in the preantibiotic era was 80-90%. The mortality rate is currently 8-17% The mortality is 17-34% if the tuberculous pericarditis is associated with HIV.

Traumatic Pericardial Injury
In penetrating injuries, pericardial effusion and tamponade may develop rapidly. Early detection and early treatment of cardiac tamponade is associated with a good prognosis. Minor perforations, isolated right ventricular wounds, and a systolic blood pressure more than 50 mm Hg are all associated with better outcomes.

Malignant Pericarditis
Pericarditis associated with malignancy is associated with poorer outcomes and a more complicated course.

Autoimmune Disease
Pericarditis associated with scleroderma and rheumatic fever is associated with worse outcomes.

Renal Failure
Pericarditis associated with renal failure is associated with significant morbidity and may result in hemorrhagic pericarditis