~Teachingcenter的醫學筆記~

可以先參考這篇文章：

http://jerryljw.blogspot.com/2015/02/acute-pericarditis.html

Etiologies:
= Idiopathic
= Infectious
---Viral (common in developed countries): Enteroviruses (Coxsackieviruses, Echoviruses), Herpesviruses, Adenoviruses
---Bacterial (rare): Pneumococcus, Streptococcus
---Mycobacterium tuberculosis (common in developing countries)
= Neoplastic: Lymphoma, Lung, Breast carcinoma, Mesothelioma
= Autoimmune
---Connective tissue disease: SLE, Sjogren syndrome, Scleroderma
---Postcardiac injury syndrome: AMI (Dressler syndrome), Post-pericariotomy
※Dressler syndrome：起因於心肌細胞或心包膜在受損
= Metabolic
---Uremia
---Drug-induced (rare): Procainamide, Hydralazine
---Radiation injury

Symptoms and Signs:
= Fever
= Elevation of inflammatory markers: CRP and ESR
= Pericarditic chest pain
---Sudden onset, anterior and referred to neck and arms
---Relieved by sitting up, leaning forward and worsened by lying down
= Pericardial friction rub
---85% of the patients
---High-pitched scatching sound in left sternal border
---Three components: Atrial systole, Ventricle systole, Early ventricular diastole
= Pericardial effusion

ECG manifestations:
= PR depression and ST-elevation (in I, II, III, aVF, V5-6)
---Stage 1: Widespread concave ST elevation with reciprocal ST depression in V1 and aVR
---Stage 2: Normalization
---Stage 3: Diffuse T inversion
---Stage 4: Normal or T inverted

Treatment:
= NSAIDs
---Aspirin or Ibuprofen for idiopathic or viral pericarditis
=Colchicine
---Treatment and Prevention of recurrent pericarditis
= Corticosteroid
= Hyperimmune globulin
---Cytomegalovirus or Adenovirus

Prognosis:
= Most patients with acute pericarditis (idiopathic or viral) have a good long-term prognosis
= Approximately 15~30% of acute pericarditis will develop incessant or recurrent pericarditis
---Colchicine may halve the rate of recurrence
= Cardiac tamponade rarely occurs with acute pericarditis
= The risk of developing chronic constrictive pericarditis
---Low (<1%) for iodiopathic or viral pericatditis
---Intermediate (2~5%) for autoimmune and neoplastic etiologies
---High (20~30%) for bacterial etiologies