Pericarditis Causes

Aka: Pericarditis Causes

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II. Causes: Common

  1. Idiopathic (Most common cause, >50% of episodes)
  2. Viral Infection (esp. Coxsackievirus)
    1. Post-Viral Pericarditis is the most common cause (up to 80% to 90% of cases) in the developed world
    2. Often labeled as idiopathic Pericarditis (but suspected to be viral)
  3. Post-MI Pericarditis
  4. Uremic Pericarditis
  5. Medication Causes of Pericarditis
  6. Acquired Immunodeficiency Syndrome (AIDS)
  7. Mycobacterium tuberculosis
    1. See Tuberculous Pericarditis
    2. Most common cause (70%) in developing countries where Tuberculosis is endemic

III. Causes: Infection

  1. Viral (common)
    1. Enteroviruses
      1. Coxsackievirus (Most common viral cause)
      2. Echovirus
    2. Herpes Viruses
      1. Cytomegalovirus (CMV)
      2. Epstein-Barr Virus (Mononucleosis)
      3. Human Herpesvirus 6
      4. Varicella Virus
    3. Viral Hepatitis
      1. Hepatitis A
      2. Hepatitis B
      3. Hepatitis C
    4. Human Immunodeficiency Virus
      1. Acquired Immunodeficiency Syndrome or AIDS (occurs in 20% of AIDS Cases)
    5. Other viruses
      1. Adenovirus
      2. Influenza
      3. Parainfluenza
      4. Parvovirus B19
      5. Mumps Virus
      6. MeaslesVirus
  2. Bacterial (Purulent Pericarditis, <5% of cases overall, <1% of cases in western europe and U.S.)
    1. Coxiella Burnetii
      1. Most common of the nontuberculous purulent causes
    2. Borelia Burgdorferi
      1. Most common of the nontuberculous purulent causes
    3. Staphylococcus aureus (high mortality)
      1. Empyema with direct spread or hematogenous spread in children
    4. Streptococcus Pneumoniae
      1. More common prior to current Immunizations in U.S.
    5. HaemophilusInfluenzae
      1. More common prior to current Immunizations in U.S.
    6. Mycobacterium tuberculosis (mortality approaches 85% for untreated cases)
      1. See Tuberculous Pericarditis
      2. Most common cause in developing countries where Tuberculosis is endemic
    7. Other Bacterial causes
      1. Actinomyces neuii
      2. Chlamydia species
      3. KlebsiellaPneumoniae
      4. Legionella species
      5. LIsteria species
      6. Meningococcus
      7. Photobacterium damselae
      8. Providencia stuartii
      9. Pseudomonas aeruginosa
      10. Rickettsia
      11. Salmonella species
      12. Syphilis
      13. Whipple Disease (Tropheryma whipplei)
  3. Fungal
    1. Aspergillosis
    2. Blastomycosis
    3. Candidiasis
    4. Coccidioidomycosis
    5. Cryptococcus
    6. Histoplasmosis
  4. Parasites
    1. Echinococcosis
    2. Toxoplasma
    3. Trypanosoma cruzi
    4. Entamoeba histolytica (Amebiasis)
    5. Löffler syndrome (Ascariasis and other Parasitic Infections)

IV. Causes: Cardiovascular

  1. Thoracic Aortic Dissection
  2. Post-cardiac procedures (e.g. PTCA, Cardiac Ablation, Pacemaker placement)
  3. Chest Trauma
  4. Pulmonary Arterial Hypertension
  5. Myocardial Infarction
    1. Acute Myocardial Infarction (in first 2-4 days following event)
    2. Post-MI Syndrome (Dressler's Syndrome, occurs in weeks to months following event)

V. Causes: Malignancy

  1. Malignant Pericardial Effusion: 15% of cancer patients
  2. Metastatic
    1. Breast Cancer (most common)
    2. Lung Cancer (most common)
    3. Leukemia
    4. Lymphoma
    5. Malignant Melanoma
  3. Primary
    1. Pericardial cardiac angiosarcoma
    2. Mesothelioma
  4. Cancer treatment complications
    1. Chest radiation
    2. Chemotherapy

VI. Causes: Autoimmune Disorders

  1. Ankylosing Spondylitis
  2. Celiac Sprue
  3. Dermatomyositis
  4. Familial mediterranean fever
  5. Granulomatosis with Polyangiitis (previously known as Wegener's Granulomatosis)
  6. Inflammatory Bowel Disease
  7. Polyarteritis Nodosa
  8. Rheumatic Fever
  9. Rheumatoid Arthritis
  10. Sarcoidosis
  11. Scleroderma
  12. Sjogren Syndrome
  13. Still Disease
  14. Systemic Lupus Erythematosus
  15. Systemic Vasculitis (e.g. Behcet Syndrome, Giant Cell Arteritis, Eosinophilic Granulomatosis with Polyangiitis)

VII. Causes: Miscellaneous causes

  1. See Medication Causes of Pericarditis
  2. Anorexia Nervosa
  3. Esophageal Rupture
  4. Uremic Pericarditis
  5. Hypothyroidism
  6. Pancreatitis
  7. Radiation Therapy
  8. Pregnancy
  9. Gout
  10. Hypothyroidism (Myxedema)

VIII. References

  1. Klasek and Alblaihed (2023) Crit Dec Emerg Med 37(6): 4-11
  2. Ariyarajah (2007) Cardiol Rev 15(1): 24-30 [PubMed]
  3. Imazio (2007) Int J Cardiol 118(3): 286-94 [PubMed]
  4. Lange (2004) N Engl J Med 351:2195-202 [PubMed]
  5. Peterson (2024) Am Fam Physician 109(5): 441-6 [PubMed]
  6. Synder (2014) Am Fam Physician 89(7): 553-60 [PubMed]
  7. Tingle (2007) Am Fam Physician 76: 1509-14 [PubMed]
  8. Troughton (2004) Lancet 363: 717-27 [PubMed]

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