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Non-infectious Pericarditis

Last updated Dec. 11, 2018

Approved by: Maulik P. Purohit MD, MPH

DoveMed.com

Microscopic pathology image of pericardium showing pericarditis.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Non-Infectious Pericardial Inflammation
  • Pericarditis due to Non-Infectious Agents

What is Non-infectious Pericarditis? (Definition/Background Information)

  • Pericarditis refers to swelling and inflammation of the pericardium, a sac-like layer that covers the heart. The pericardium contains a fluid that keeps the heart muscle moist and ensures a smooth function
  • Generally, this sac becomes inflamed due to an underlying infection that results in friction between the membrane and muscle causes a stabbing chest pain, thereby leading to pericarditis. However, in some cases, pericarditis may be caused by non-infectious agents or underlying disorders
  • Non-Infectious Pericarditis may be the result of autoimmune disorders, such as systemic lupus erythematosus or rheumatoid arthritis, kidney failure, following a heart attack resulting in trauma to the chest, certain genetic disorders, etc.
  • The actual site of origin of the underlying condition may be in another area of the body, as a result of which complications can arise and affect the pericardium. In general, pericarditis can also be caused by a viral, bacterial, or fungal infection
  • The treatment of Non-Infectious Pericarditis primarily involves treating the underlying disorder. The prognosis depends on many factors, such as the severity of the underlying condition; although in most cases with appropriate treatment, it is good
  • Non-Infectious Pericarditis, in some cases, can become a chronic condition. However, in a majority of the individuals the condition is generally short-lived

Who gets Non-infectious Pericarditis? (Age and Sex Distribution)

  • Non-Infectious Pericarditis constitute about 5-10% of all types of pericarditis
  • It is more common in individuals in the 20-50 year age group
  • Both males and females may be affected, though the condition is more common in males
  • No racial, ethnic, or geographical preferences are seen

What are the Risk Factors for Non-infectious Pericarditis? (Predisposing Factors)

Non-Infectious Pericarditis risk factors may include the following:

  • Autoimmune disorders that include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and scleroderma
  • Acute kidney failure that may occur due to a variety of reasons
  • Connective tissue disorders
  • Genetic disorders including familial mediterranean fever (FMF)
  • Post heart attack; trauma to the chest due to other reasons
  • Cancers including leukemia
  • Following radiation therapy to the chest region; the higher the dosage and longer the duration of therapy, the greater is the risk. This can lead to radiation-induced pericarditis
  • Weak immune system, due to immunosuppressive therapy
  • Following surgical procedures such as cardiac catheterization, radio frequency ablation (RFA), or a by-pass surgery
  • Hypothyroidism
  • Use of certain medications resulting in drug-induced pericarditis
  • A previous diagnosis of acute pericarditis may increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Non-infectious Pericarditis? (Etiology)

Non-Infectious Pericarditis may be caused by a variety of factors that include the following:

  • Underlying disorders that affect the immune system such as systemic lupus erythematosus, rheumatoid arthritis, certain genetic conditions, connective tissue disorders, cancer, kidney failure, hypothyroidism, etc.
  • Medical procedures performed previously to the chest including radiation therapy, certain surgical procedures (such as cardiac catheterization, RFA)
  • Injury to the chest due to heart attack

Pericarditis, in general, may also occur due to infectious pathogens such as a virus, bacteria, or fungus; although, in a majority of cases, the cause of pericarditis remains unidentified (idiopathic pericarditis).

What are the Signs and Symptoms of Non-infectious Pericarditis?

The signs and symptoms of Non-Infectious Pericarditis include, but are not limited to, the following:

  • Low-grade fever, chills, sweating
  • Chest pain; pain in chest increases on coughing or swallowing
  • Dry cough
  • Fatigue, anxiety
  • Difficulty breathing, which gets worse especially while reclining or lying down, but gets better on sitting, leaning forward or standing
  • Rapid heart rate, heart palpitations
  • Pain in the back
  • Swelling of the legs and feet (edema)
  • Signs and symptoms of the underlying condition or disorder

How is Non-infectious Pericarditis Diagnosed?

A diagnosis of Non-Infectious Pericarditis may be made as follows:

  • A thorough physical examination with a complete medical history
  • If symptoms are noted, the healthcare provider may need a full medical history to correlate the condition and rule out other possible causes of infection
  • A stethoscope is used to listen to the heartbeat; if a faint sound is heard, it can usually raise suspicion/concern for the healthcare provider

A series of tests to view structures and fluid present in the heart may then be ordered, for further observation of the condition. These tests may include:

  • Blood test to determine the underlying disorder
  • Blood culture to determine the causative organism, if bacterial or fungal infection is suspected
  • X-ray of chest
  • CT or MRI scan of the chest
  • Echocardiogram

The radiology imaging tests may show the presence of any abnormal fluid levels around the heart, within the pericardial sac.

  • Sometimes, depending on the clinical situation, abnormal fluid in the pericardial sac may be cultured, to determine if there is an infectious cause
  • The fluid is collected by aspiration through a procedure called pericardiocentisis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Non-infectious Pericarditis?

The following complications may occur due to Non-Infectious Pericarditis:

  • Constrictive pericarditis, a condition wherein the heart function is restricted, due to compression by the surrounding pericardial sac
  • Swelling of the lungs (pulmonary edema)
  • Cardiac tamponade (accumulation of excess fluid)
  • Shock: A condition which can result in failure of vital organs in the body
  • Complications that arise from the underlying condition or disorder
  • The condition may recur (recurrent pericarditis) or last for many years (chronic pericarditis)

How is Non-infectious Pericarditis Treated?

The underlying condition must be treated, in order to effectively control and cure pericarditis. The treatment of Non-Infectious Pericarditis may include the following measures:

  • The use of medications to manage pain such as:
    • Analgesics (to relieve pain)
    • Anti-inflammatory medication (to decrease inflammation)
  • Most cases of Non-Infectious Pericarditis are due to autoimmune disorders, and hence, steroidal therapy may be used to treat underlying disorder
  • Plenty of rest (bed rest) will be recommended as well
  • If there is a severe buildup of fluid, a small cut is made in the pericardium, to allow drainage of the fluid. This procedure is called pericardiocentesis
  • Additionally, diuretics to help decrease excess fluid accumulation in the body, may be administered
  • The treatment for recurrent pericarditis (arising from acute pericarditis) is using colchicine medication

How can Non-infectious Pericarditis be Prevented?

A few preventative tips for Non-Infectious Pericarditis may include:

  • Undertaking proper treatment of underlying autoimmune conditions and other disorders
  • Maintaining a healthy lifestyle and diet
  • If an individual has a weakened immune system, then appropriate treatment to boost the immune system can help prevent Non-Infectious Pericarditis

What is the Prognosis of Non-infectious Pericarditis? (Outcomes/Resolutions)

  • Non-Infectious Pericarditis can lead to life-threatening symptoms, if the condition is left untreated. The prognosis depends on the severity of the signs and symptoms of the underlying condition
  • If the condition is diagnosed early and treated effectively, the affected individuals typically make a full recovery

Additional and Relevant Useful Information for Non-infectious Pericarditis:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/common-procedures/procedures-laboratory/pericardial-fluid-analysis/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 19, 2016
Last updated: Dec. 11, 2018