Tuesday, April 14, 2009

"Shot through the heart, and you're to blame.....You give love a bad name "......Bon Jovi, circa 1986

Pericarditis: an approach....
  1. Idiopathic: many patients do not have an underlying etiology established. We assume that many of these patients have a 'viral' pericarditis.
  2. Infectious:
    • Viral: classically Coxsackie, Echovirus, and Adenovirus, but certainly others.
    • Bacterial: think about Staph and Strep species, and never forget TB (mycobacterial)
    • Fungal: Histoplasmosis, Aspergillosis, Blastomycosis
    • Parasitic: Toxoplasomosis, Echinococcus
  3. Malignant: usually metastatic disease like lung or breast cancers, or lymphoma.
  4. Autoimmune: Think about lupus, rheumatoid arthritis, and mixed connective tissue diseases.
  5. Metabolic: Uremic pericarditis is common, and hypothyroidism can cause a pericardial effusion.
  6. Cardiac: a pericarditis can be seen early after an infarction, or sometimes within 3-4 weeks afterwards....the so called Dressler's Syndrome.
  7. Drugs: can cause a drug-induced lupus. Common culprits include procainamide, INH, and hydralazine.
  8. Other things: Radiation, Trauma.

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