Materiały źródłowe

• #1 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Pericarditis refers to inflammation of the pericardial sac surrounding the heart and is the most common pathological condition affecting the pericardium. This condition can be classified into acute, incipient or subacute, chronic, and recurrent pericarditis, which is estimated to occur in about 30% of cases. Pericarditis may also present alongside other pericardial syndromes, including pericardial effusion, cardiac tamponade, constrictive pericarditis, and effusive-constrictive pericarditis. […] The parietal layers rich innervation makes it highly sensitive to inflammation caused by infectious, autoimmune, or traumatic insults, often resulting in severe retrosternal chest pain, as seen in acute pericarditis. This explains why over 90% of patients with pericarditis present with chest discomfort. In cases of pericardial effusion, increased pericardial compliance allows the sac to dilate over time in response to slowly accumulating fluid, preventing compression of the cardiac chambers. Consequently, the rate of fluid accumulation and the resulting pressure changes often has a greater impact than the volume in determining the hemodynamic effects on the heart.

• #1

  https://journals.lww.com/jpcs/fulltext/2019/05020/constrictive_pericarditis.11.aspx

  Constrictive pericarditis arises after a cycle of injury and inflammation, which might be initiated several days, months, or years before clinical presentation, although the precise event often remains elusive. […] Damage to pericardial mesothelial cells is associated with an acute reduction of tissue-type plasminogen activator and reduced fibrinolytic activity, with fibrinous inflammation and adhesion formation, which is a possible mechanism for pericardial fibrosis, although this mechanism is yet to be proven. […] Most patients (80%) with constrictive pericarditis who undergo pericardiectomy have nonspecific fibrocalcific thickening of the pericardial tissue, with evidence of ongoing acute or chronic inflammation of the pericardium. […] In contrast to late presentations, reduced pericardial compliance early in the disease course (usually 3 months) is more often caused by inflammation than by fibrosis.

• #1 Acute Pericarditis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/156951-overview

  Pericardial physiology includes three main functions. First, through its mechanical function, the pericardium promotes cardiac efficiency by limiting acute cardiac dilation, maintaining ventricular compliance with preservation of the Starling curve, and distributing hydrostatic forces. The pericardium also creates a closed chamber with subatmospheric pressure that aids atrial filling and lowers transmural cardiac pressures. Second, through its membranous function, the pericardium shields the heart by reducing external friction and acting as a barrier against extension of infection and malignancy. Third, through its ligamentous function, the pericardium anatomically fixes the heart. […] In most cases of acute pericarditis, the pericardium is acutely inflamed and has an infiltration of polymorphonuclear (PMN) leukocytes and pericardial vascularization. Often, the pericardium manifests a fibrinous reaction with exudates and adhesions. The pericardium may develop a serous or hemorrhagic effusion. A granulomatous pericarditis occurs with tuberculosis, fungal infections, rheumatoid arthritis (RA), and sarcoidosis. In recurrent pericarditis, the innate immune system appears to play a role in its pathogenesis.

• #1 Diagnosing Pericarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/1101/p1695.html

  Pericarditis, or inflammation of the pericardium, is most often caused by viral infection. It can also develop as a result of bacterial or other infection, autoimmune disease, renal failure, injury to the mediastinal area, and the effects of certain drugs (notably hydralazine and procainamide). […] Over time, pericarditis can result in chronic inflammation with thickening and, ultimately, calcification of the pericardium. This condition is known as chronic constrictive pericarditis. Conversely, rapid accumulation of serous fluid can result in acute compression of the cardiac chambers, with dire hemodynamic consequences. This condition, which is called cardiac tamponade, may occur in up to 15 percent of patients with severe pericarditis. […] Depending on the underlying cause, the acute inflammatory response in pericarditis may produce serous fluid, pus, or dense fibrinous material. Viral pericarditis usually results in small accumulations of serous fluid that resolve spontaneously or require minimal therapeutic intervention.

• #1 Pathogenesis of Pericarditis and its Diagnosis

  https://www.longdom.org/open-access/pathogenesis-of-pericarditis-and-its-diagnosis-97959.html

  Pericarditis is a polyetiological infectious or non-infectious (aseptic) inflammatory disease, the most common visceral leaf that occurs as a complication of various diseases. […] Acute pericarditis begins with limited catarrhal and then fibrous inflammation, a small amount of effacing is subjected to reverse absorption, and fibrin strands are deposited on the visceral and parietal leaves of pericardium dry pericarditis. Then there is total inflammation, exudate accumulates in large quantities effusion. […] As the inflammatory process subsides, the exudate is absorbed, and in the pericardium sheets the granular tissue grows, which is then replaced by connective tissue fibers, if connective tissue adhesives are formed between pericardium leaves. If the scar tissue absorbs the entire pericardium cavity, it tightens the visceral and parietal leaves, which leads to a pronounced compression of the heart. This outcome of sweaty pericarditis was called a constrictor, or squeezing. In some cases, calcium is deposited in the scar-changed pericardium and the pericardium is calcified, which turns into a rigid, dense and sedentary bag (shell) surrounding the heart (shell heart).

• #1 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  Similarities exist between recurrent pericarditis and autoinflammatory diseases, including familial Mediterranean fever (FMF) and tumor necrosis factor-associated periodic syndrome (TRAPS). These syndromes are characterized by seemingly unprovoked attacks of multisystem inflammation with serositis, systemic symptoms and strikingly elevated CRP, and are triggered by innate immunity perturbations in the absence of antigen specific T cells or autoantibodies. […] To better understand the pathophysiology of autoinflammatory disease, research has focused on the pivotal role of the inflammasome, that is an enzymatic complex that at the end activates IL1, a potent inflammatory cytokine. […] This emerging focus on the inflammasome has also highlighted an important distinction in patients with complicated pericardial disease: those with a tendency toward inappropriate autoinflammation versus those with predominant autoimmune disease.

• #1 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://www.wjgnet.com/1949-8462/full/v10/i9/87.htm

  Patterns of inflammation and fibrosis in the pericardium suggest that both myocardial and pericardial cells play a role in the pathogenesis of pericarditis and constriction. […] The active regulation of both pro- and anti-inflammatory mediators by mesothelial cells suggests a key role for the cells in maintaining pericardial homeostasis and also in the pathogenesis of pericardial fibrosis. […] Increased pericardial fluid and serum levels of TGF- have been described in various forms of pericarditis and have been associated with increased collagen synthesis. […] Lowered Ac-SDKP levels could arise from an increase in angiotensin converting enzyme (ACE) activity, which is known to degrade Ac-SDKP.

• #1 Acute recurrent pericarditis: from pathophysiology towards new treatment strategy | Heart

  https://heart.bmj.com/content/106/14/1046

  Acute idiopathic or so-called viral pericarditis is a frequent and usually benign disease, although recurrences are frequent. […] Data strongly suggest the presence of underlying autoinflammatory and/or autoimmune disorders. […] It has been reported that there is an inflammatory response of the innate immune system typical of autoinflammatory diseases, predominantly mediated by interleukin-1 (IL-1). […] The inflammatory response of the adaptive immune system, typical of autoimmune diseases mainly mediated by autoantibodies or autoreactive T lymphocytes seems also involved as anti-heart or anti-intercalated disk autoantibodies were associated with a higher number of recurrences and hospitalisations. […] Growing evidences suggest a place of IL-1 receptor antagonists in the treatment of recurrent pericarditis.

• #1 Interleukin-1 Blockers in Recurrent and Acute Pericarditis: State of the Art and Future Directions

  https://www.mdpi.com/1648-9144/60/2/241

  The most studied inflammasome is the ubiquitous NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) inflammasome, also known as cryopyrin. […] In the context of AP, an initial trigger leads to the release of DAMPs or PAMPs, which bind to cellular pattern recognition receptors (PRRs), thus activating several intracellular pathways that ultimately lead to an increase in transcription of NLRP3 inflammasome. […] Overall, RP shows clear similarities with autoinflammatory diseases, a group of disorders characterized by innate immune system dysfunction. […] In this context, some anti-IL1 antagonists have been studied and approved also for steroid-dependent and colchicine-refractory pericarditis.

• #1 researchopenworld.com

  https://researchopenworld.com/the-role-of-interleukin-1%CE%B2-in-the-pathogenesis-and-treatment-of-acute-pericarditis/

  Interleukin-1β is produced as a 269-AA precursor protein, and is processed by caspase-1 activated in the inflammasomes into its mature active form. […] Interleukin-1β signaling is via two surface receptors, IL-1R1, and IL-1 type 2 receptor (IL-1R2), a decoy receptor. […] Interleukin 1β and its receptors, coreceptor, and decoy receptor are favourable therapeutic targets in cardiovascular diseases, including acute and recurrent pericarditis. […] Interleukin-1β antagonists, such as anakinra and rilonacept should be initiated early in the course of acute pericarditis in order to avert the troublesome complications of acute pericarditis, such as recurrent pericarditis, cardiac tamponade, and constrictive pericarditis.

• #1 Recurrent pericarditis: current challenges and future prospects | RRCC

  https://www.dovepress.com/recurrent-pericarditis–current-challenges-and-future-prospects-peer-reviewed-fulltext-article-RRCC

  Recurrent pericarditis, usually idiopathic, is difficult to treat. […] The pathophysiology of idiopathic pericarditis involves autoimmunity and autoinflammation in various degrees and is usually caused by a microbacteriological or postinjury trigger. […] The role of autoimmunity is suggested by several elements: 1) the presence of antinuclear antibodies is more common in patients suffering from IRAP (43.4%) than among controls (9.8%); 2) the presence of antiheart and anti-intercalated disk antibodies in 67.5% of patients with IRAP probably induced by overexposure to self-antigens secondary to myocardial or pericardial disease: pericardiotomy, myocardial infarction, pacemaker implant, and so on; 3) the presence of proinflammatory cytokines (interleukin [IL]-6, IL-8, and interferon-) in the pericardial fluid, but not in the plasma, indicating a local inflammation; and 4) the incidence of pericardial disease in connective tissue disease and vasculitis.

• #1 Recurrent pericarditis: current challenges and future prospects | RRCC

  https://www.dovepress.com/recurrent-pericarditis–current-challenges-and-future-prospects-peer-reviewed-fulltext-article-RRCC

  This inflammatory stimulation could be triggered in the absence of systemic disease or myocardial damage by a misdirected immune reaction against microorganisms, usually viral, even when serologies are negative. […] Monogenic autoinflammatory diseases inborn anomalies of inflammation of genetic origin are complicated with pericardial disease in nearly one-third of cases, but this involvement is rarely isolated and often begins in childhood. […] The identification of these patients means that their treatment can be adapted specifically: anakinra, a recombinant IL-1 receptor antagonist, is very effective due to the increased secretion of IL-1, secondary to hyperactivity of the inflammasome. […] The presence of IL-8 in plasma could be a predictive factor of recurrence during acute pericarditis.

• #1 The Use of Colchicine in Pericardial Diseases

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases

  Colchicine has since been the focus of many observational and randomized studies for pericardial diseases. […] The anti-inflammatory effect of colchicine differs from conventional non-steroidal anti-inflammatory drugs (NSAIDs) and steroids in that it does not act on the arachidonic acid pathway. Rather, it targets white blood cells (WBCs) and causes microtubule depolymerization, which in turn inhibits motility, phagocytosis and degranulation of the WBCs. […] It also inhibits interleukin-1beta (IL-1) and interleukin-18 (IL-18) by interfering with NLRP3 inflammasome protein complex, which is increasingly recognized as playing a role in acute coronary syndrome, crystal-induced gout and more importantly recurrent idiopathic pericarditis. […] The pathophysiology is poorly understood and is thought to be, at least in part, an auto-immune reaction to the myocardial injury.

• #1 Pericarditis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pericarditis_pathophysiology

  Pericarditis is inflammation of the pericardium, which is the double-walled sac that contains the heart and the roots of the great vessels. […] Cardiotropic viruses usually spread to the myocardium and pericardium hematogenously and cause acute inflammation with infiltration of polymorphonuclear (PMN) leukocytes and pericardial vascularization. This may cause pericardial effusion and fibrinous change of the pericardium. The pericardium may also develop a serous or hemorrhagic effusion. Most patients with viral pericarditis recover completely with few developing recurrences. Some patients develop constrictive pericarditis which could be disabling. […] Bacterial pericarditis results from contiguous spread of infection within the chest, either de novo or after surgery or trauma, spread from infective endocarditis, hematogenous spread of infection, or direct inoculation as a result of penetrating injury or cardiothoracic surgery.

• #1 Acute Pericarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1115/p1509.html

  Although acute pericarditis is most often associated with viral infection, it may also be caused by many diseases, drugs, invasive cardiothoracic procedures, and chest trauma. […] The clinical syndrome of pericarditis results from inflammation of the pericardium, a fibrous sac that envelops the heart and the base of the great vessels. […] Pericarditis may present as an indolent process with no significant pain, as seen in patients with tuberculosis, or it may be heralded by the sudden onset of severe substernal chest pain in acute idiopathic or viral pericarditis. […] The acute inflammatory response in pericarditis can produce either serous or purulent fluid, or a dense fibrinous material. […] In viral pericarditis, the pericardial fluid is most commonly serous, is of low volume, and resolves spontaneously.

• #1 Pericarditis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pericarditis_pathophysiology

  Tuberculous pericarditis develops from lymphatic spread of peritracheal, peribronchial or mediastinal lymph nodes or by contiguous spread from a focus of infection in the lung or pleura. There are four pathologic stages observed: Stage 1: Presence of diffuse fibrin deposition, granulomas and abundant mycobacterium. Stage 2: Development of serous or serosanguineous pericardial effusion with a predominantly lymphocytic exudate with monocytes and foam cells. Stage 3: Absorption of effusion with the organization of granulomatous caseation and thickening of pericardium secondary to deposition of fibrin and collagen. Stage 4: Development of constrictive pericarditis. The pericardial space is obliterated by dense adhesions with marked thickening of the parietal layer and replacement of granulomas by fibrous tissue.

• #1 Pericarditis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pericarditis_pathophysiology

  Pericarditis in renal failure is thought to result from inflammation of the visceral and parietal layers of the pericardium by metabolic toxins such as urea, creatinine, uric acid, methylguanidine, guanidinoacetate, parathyroid hormone, beta2-microglobulin, and others. It may be associated with hemorrhagic or serous effusion.

• #1 Pericarditis – Cardiovascular Diseases – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.2.17.

  Pericarditis is the most common pericardial syndrome worldwide. It refers to an inflammatory process involving the pericardial sac. […] The mechanism for pericardial fluid accumulation in malignancy may be related to pericardial inflammation caused directly by cancer cells in the pericardium because of treatment (ie, certain chemotherapies or radiation) or obstruction of lymphatic drainage of pericardial fluid by malignant deposits.

• #1 Constrictive Pericarditis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/157096-overview

  Constrictive pericarditis occurs when a thickened fibrotic pericardium, of whatever cause, impedes normal diastolic filling. […] This often leads to pericardial inflammation, chronic fibrotic scarring, calcification, and restricted cardiac filling. […] Acute and subacute forms of pericarditis (which may or may not be symptomatic) may deposit fibrin, which, in turn, can evoke a pericardial effusion. […] In constrictive pericarditis, the easily distensible, thin parietal and visceral pericardial linings become inflamed, thickened, and fused. Because of these changes, the potential space between the linings is obliterated, and the ventricle loses distensibility. Venous return to the heart becomes limited, and ventricular filling is reduced, with associated inability to maintain adequate preload. Filling pressures of the heart tend to become equal in both the ventricles and the atria.

• #1

  https://journals.lww.com/jpcs/fulltext/2019/05020/constrictive_pericarditis.11.aspx

  The principal hemodynamic abnormality in constrictive pericarditis is loss of pericardial compliance, with a reliance on elevated ventricular pressures to maintain cardiac filling and output, which eventually leads to primary diastolic heart failure. […] In patients with constrictive pericarditis, increased pericardial constriction leads to a fairly fixed combined volume of the left and right ventricles, such that atrioventricular filling of the right ventricle increases with inspiration and decreases with expiration. […] Exertional dyspnea in constrictive pericarditis is the result of limited or no increase in cardiac output with physical exertion. […] Ascites in constrictive pericarditis is out of proportion to pedal edema. It usually occurs earlier than pedal edema. This is referred to as ascites precox.

• #1 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6189073/

  The active regulation of both pro- and anti-inflammatory mediators by mesothelial cells suggests a key role for the cells in maintaining pericardial homeostasis and also in the pathogenesis of pericardial fibrosis. […] TGF- is a master regulator of extracellular matrix component expression and the development of fibrosis. […] Increased pericardial fluid and serum levels of TGF- have been described in various forms of pericarditis and have been associated with increased collagen synthesis. […] Ac-SDKP, which is known to decrease TGF- signalling by decreasing TGF- transcription and the phosphorylation of Smad2 and Smad3 and their translocation to the nucleus, may play a role in the pathway to pericardial fibrosis. […] An increase in CTGF was associated with ECM deposition and pericardial remodelling.

• #1 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6189073/

  The fibrotic cascade of events is triggered upon insult to epithelial or endothelial cells which results in the activation of the coagulation cascade. […] The initial inflammatory response is characterised by the release of various pro-inflammatory cytokines, including tumour necrosis factor-, TNF-. […] Molecular mechanisms of pericardial constriction remain to be fully elucidated but are likely to follow a classical pattern of pericardial inflammation mediated by various cytokines, including TNF-, followed by abnormal healing with an exaggerated TGF- mediated profibrotic response leading to pericardial fibrosis. […] Patterns of inflammation and fibrosis in the pericardium suggest that both myocardial and pericardial cells play a role in the pathogenesis of pericarditis and constriction.

• #1 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://www.wjgnet.com/1949-8462/full/v10/i9/87.htm

  While the predictors of progression to constriction following acute pericarditis are poorly understood the incidence of constrictive pericarditis is significantly dependent on the aetiology of the pericarditis. […] The fibrotic cascade of events is triggered upon insult to epithelial or endothelial cells which results in the activation of the coagulation cascade. […] The initial inflammatory response is characterised by the release of various pro-inflammatory cytokines, including tumour necrosis factor-, TNF-. […] Molecular mechanisms of pericardial constriction remain to be fully elucidated but are likely to follow a classical pattern of pericardial inflammation mediated by various cytokines, including TNF-, followed by abnormal healing with an exaggerated TGF- mediated profibrotic response leading to pericardial fibrosis.

• #1 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  The prognostic role is promising for carcinoembryonic antigen cell adhesion molecule 1 (CEACAM1), which is an immune inhibitory protein, and for MHC class I chain related protein A (MICA), which exhibits an immune stimulating function in patients with acute and recurrent pericarditis. […] CEACAM1 and MICA are serum proteins that can be released from damaged or inflamed tissues in patients with pericarditis. […] The authors concluded that CEACAM1 could serve as a potentially novel biomarker for pericarditis, and MICA as an innovative prognostic marker in these patients.

• #1 Pericarditis – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/myocarditis-and-pericarditis/pericarditis

  Pericarditis may be caused by many disorders (eg, infection, myocardial infarction, trauma, tumors, metabolic disorders) but is often idiopathic. […] Acute pericarditis develops quickly, causing inflammation of the pericardial sac and often a pericardial effusion. Inflammation can extend to the epicardial myocardium (myopericarditis). […] Acute disease may resolve completely, resolve and reoccur (up to 30% of acute cases) or become subacute or chronic. […] Chronic pericarditis is defined as pericarditis persisting 6 months. […] Cardiac tamponade occurs when a moderate or large pericardial effusion impairs cardiac filling, leading to low cardiac output and sometimes shock and death. […] Constrictive pericarditis results from marked inflammatory, fibrotic thickening of the pericardium.

• #1 Acute Pericarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1115/p1509.html

  Neoplastic, tuberculous, and purulent pericarditis may be associated with large effusions that are exudative, hemorrhagic, and leukocyte filled. […] Although pericardial effusion may be absent in 60 percent of patients, large pericardial effusions may accumulate rapidly and impede diastolic filling of the right heart, resulting in cardiac tamponade and death. […] Cardiac tamponade associated with acute pericardial disease is more common in patients with neoplastic, tuberculous, and purulent pericarditis (60 percent) than in patients with acute viral pericarditis (14 percent). […] Prolonged pericarditis may result in persistent accumulation of pericardial fluid. In this case, the fluid constitutes to form a thick coating that surrounds the myocardium. The ultimate manifestation may be constrictive pericarditis.

• #1 Acute Pericarditis Treatment: Update on Colchicine

  https://www.uspharmacist.com/article/acute-pericarditis-treatment-update-on-colchicine

  Acute pericarditis (inflammation of the pericardial sac) is the most common pericardial disease, accounting for 5% of emergency department admissions in patients presenting with nonischemic chest pain. In the United States, most cases of acute pericarditis in immunocompetent hosts are predominantly of idiopathic or viral origin. Other causes include radiation; malignancies; trauma; infectious diseases (e.g., mycoplasmal, fungal, bacterial); drugs (e.g., procainamide, isoniazid, hydralazine); autoimmune disorders (e.g., lupus, rheumatoid arthritis, vasculitis, scleroderma, sarcoidosis, inflammatory bowel disease); metabolic disorders (hypothyroidism, uremia, ovarian hyperstimulation syndrome); and cardiac disorders (early infarction, postcardiac injury, myocarditis, dissecting aortic aneurysm).

• #1 researchopenworld.com

  https://researchopenworld.com/the-role-of-interleukin-1%CE%B2-in-the-pathogenesis-and-treatment-of-acute-pericarditis/

  Acute pericarditis is characterized by severe inflammation of the fibrous and serous pericardial membranes covering the heart. […] It is caused by multifactorial conditions, such as systemic diseases, autoimmune inflammatory diseases, malignant tumours, bacterial and viral infections, including SARS-CoV-2. […] Interleukin-1 is a master proinflammatory cytokine existing in two isoforms, IL-1α and IL-1β, and the latter is the most studied, and is implicated in several autoinflammatory diseases, autoimmune diseases, metabolic syndromes, cardiovascular disease, including acute pericarditis. […] Interleukin-1β production and secretion is stimulated by NLRP3 inflammasome, pathogen-associated molecular patterns (PAMPs), damage-associated molecular patterns (DAMPs), and other inflammatory cytokines, such a TNFβ, IL-8, and in an autocrine fashion by IL-1β.

• #1 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://www.wjgnet.com/1949-8462/full/v10/i9/87.htm

  The pathophysiological response of the pericardium to injury is characterized by intense inflammation with or without effusion, and the clinical syndrome of pericarditis. […] The major complications of pericarditis are cardiac tamponade with and without hemodynamic instability in the short term, constrictive pericarditis in the long term and death. […] The inflammatory basis of autoimmune pericarditis, centered around the role of the inflammasome, has recently been reviewed by Xu et al. […] Constrictive pericarditis is a clinical syndrome, characterised by a thickened and non-compliant pericardium, which restricts cardiac filling. […] The most apparent pathological features of constrictive pericarditis are inflammation and fibrotic thickening of the thin and elastic parietal and visceral pericardial linings.

• #2 Pericarditis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26955

  The pericardium serves several functions, including anchoring the heart within the thoracic cavity, forming a barrier against extrinsic infections, and facilitating dynamic interaction between cardiac chambers. […] The parietal layers rich innervation makes it highly sensitive to inflammation caused by infectious, autoimmune, or traumatic insults, often resulting in severe retrosternal chest pain, as seen in acute pericarditis. […] In cases of pericardial effusion, increased pericardial compliance allows the sac to dilate over time in response to slowly accumulating fluid, preventing compression of the cardiac chambers. […] Consequently, the rate of fluid accumulation and the resulting pressure changes often has a greater impact than the volume in determining the hemodynamic effects on the heart. […] As a result, a relatively small pericardial effusion can lead to life-threatening tamponade if it accumulates rapidly, while a gradual process, such as malignancy, may allow a large pericardial effusion to develop over weeks before causing constrictive physiology in the cardiac chambers.

• #2 Pericarditis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Pericarditis_pathophysiology

  Pericarditis is inflammation of the pericardium, which is the double-walled sac that contains the heart and the roots of the great vessels. […] Cardiotropic viruses usually spread to the myocardium and pericardium hematogenously and cause acute inflammation with infiltration of polymorphonuclear (PMN) leukocytes and pericardial vascularization. This may cause pericardial effusion and fibrinous change of the pericardium. The pericardium may also develop a serous or hemorrhagic effusion. Most patients with viral pericarditis recover completely with few developing recurrences. Some patients develop constrictive pericarditis which could be disabling. […] Bacterial pericarditis results from contiguous spread of infection within the chest, either de novo or after surgery or trauma, spread from infective endocarditis, hematogenous spread of infection, or direct inoculation as a result of penetrating injury or cardiothoracic surgery.

• #2 Acute Pericarditis: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/156951-overview

  Uremic pericarditis is thought to result from inflammation of the visceral and parietal layers of the pericardium by metabolic toxins that accumulate in the body owing to kidney failure. Other factors may be involved, however, because pericarditis also may occur in patients with chronic renal failure who are already receiving dialysis therapy.

• #2 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://www.wjgnet.com/1949-8462/full/v10/i9/87.htm

  Patterns of inflammation and fibrosis in the pericardium suggest that both myocardial and pericardial cells play a role in the pathogenesis of pericarditis and constriction. […] The active regulation of both pro- and anti-inflammatory mediators by mesothelial cells suggests a key role for the cells in maintaining pericardial homeostasis and also in the pathogenesis of pericardial fibrosis. […] Increased pericardial fluid and serum levels of TGF- have been described in various forms of pericarditis and have been associated with increased collagen synthesis. […] Lowered Ac-SDKP levels could arise from an increase in angiotensin converting enzyme (ACE) activity, which is known to degrade Ac-SDKP.

• #2 Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

  https://www.wjgnet.com/1949-8462/full/v10/i9/87.htm

  While the predictors of progression to constriction following acute pericarditis are poorly understood the incidence of constrictive pericarditis is significantly dependent on the aetiology of the pericarditis. […] The fibrotic cascade of events is triggered upon insult to epithelial or endothelial cells which results in the activation of the coagulation cascade. […] The initial inflammatory response is characterised by the release of various pro-inflammatory cytokines, including tumour necrosis factor-, TNF-. […] Molecular mechanisms of pericardial constriction remain to be fully elucidated but are likely to follow a classical pattern of pericardial inflammation mediated by various cytokines, including TNF-, followed by abnormal healing with an exaggerated TGF- mediated profibrotic response leading to pericardial fibrosis.

• #2 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Acute pericarditis, the most common pericardial syndrome in clinical practice, is diagnosed based on two of the following criteria: a) chest pain b) pericardial friction-rub c) characteristic ECG changes (new widespread ST-elevation or PR depression) d) pericardial effusion. […] The aetiology is multifactorial. Viruses and tuberculosis are the most common aetiological factors in developed and developing countries, respectively. […] The aetiology is multifactorial and depends on the epidemiological background, patient population and clinical setting. […] In particular, the most common cause of pericarditis in developed countries is viruses, whereas tuberculosis is the most frequent cause in developing countries. […] Notably, the most common noninfectious causes are secondary to autoimmune diseases, metastatic tumours and post-cardiac injury syndrome.

• #2 Acute recurrent pericarditis: from pathophysiology towards new treatment strategy | Heart

  https://heart.bmj.com/content/106/14/1046

  Many retrospective studies, one recent randomised placebo-controlled study and data of a real-life large international registry showed the good efficacy of anakinra with a good safety profile. […] Other IL-1 receptor antagonists showed promising results (canakinumab, rilonacept). […] However, IL-1 receptor antagonists position in the treatment algorithm of recurrent pericarditis needs further evaluation in larger prospective clinical trials to replicate initial findings as well as to assess safety, cost-effectiveness and long-term efficacy.

• #2 Patient education: Pericarditis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pericarditis-beyond-the-basics

  The goals of treatment for pericarditis include relief of pain and resolution of inflammation and effusion. Specific treatment for the cause of pericarditis may also be required. […] When the cause of pericarditis is identified, treatment is aimed at the underlying condition. As an example, pericarditis that is caused by a bacterial infection would be treated with one or more antibiotics. However, viral pericarditis does not require any specific antiviral treatment in most patients and is treated by empiric anti-inflammatory therapies. […] Pericardiocentesis is the medical term for removal of fluid from the pericardium with a thin needle. Pericardiocentesis may be recommended for some patients with pericardial effusion or cardiac tamponade (a life-threatening complication of pericardial effusion). The procedure may be useful both as a treatment and as a tool to determine the cause of pericarditis.

Zobacz więcej