Definition
Inflammation of the pericardium, the fibrous sac that surrounds the heart. It can affect both the serous and fibrous layers, leading to functional complications such as pericardial effusion, tamponade, or constriction.
Classification
- According to duration:
- Acute: < 6 weeks
- Subacute: 6 weeks to 6 months
- Chronic: > 6 months
- According to exudate type:
- Serous
- Purulent
- Fibrinous
- Caseous
- Haemorrhagic
Etiology
- Infectious causes:
- Viral: Coxsackie, HIV, Herpes
- Bacterial: Mycobacterium tuberculosis (especially in endemic areas)
- Fungal
- Idiopathic
- Autoimmune diseases: e.g. Systemic lupus erythematosus, Rheumatic fever
- Dressler’s syndrome: autoimmune pericarditis post-MI
- Paraneoplastic: associated with malignancies
- Uremic pericarditis: in end-stage chronic renal failure due to uremic toxins
- Postpericardiotomy syndrome: after cardiac surgery
- Trauma: blunt or penetrating trauma to the heart
- Radiation-induced
- Hypothyroidism: associated with serous pericardial effusion
Pathophysiology
- Initiation by inflammatory trigger → local vasodilation (VD) and ↑ capillary permeability
- Plasma proteins, especially fibrinogen, leak into pericardial space → fibrin deposition
- Accumulation of WBCs (mainly neutrophils, lymphocytes depending on cause)
- Over time, fibrosis may develop → thickened and stiff pericardium
- This impairs diastolic filling, leading to ↓ stroke volume, ↑ HR, and potentially HF