What causes pericarditis?

, medical expert
Last reviewed: 20.11.2021

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Acute pericarditis occurs as a result of the infectious process, connective tissue diseases, uremia, trauma, myocardial infarction or under the influence of certain drugs. Infectious pericarditis most often has a viral etiology. Purulent bacterial pericarditis is rare, but can accompany infectious endocarditis, pneumonia, sepsis, occur when infected as a result of trauma or cardiosurgical intervention. Often the cause can not be identified (nonspecific, or idiopathic, pericarditis), but many of these cases probably have a viral etiology. In general, the most commonly diagnosed viral and idiopathic pericarditis. Acute myocardial infarction causes 10-15% of cases of acute pericarditis. Post-infarction syndrome (Dressler's syndrome) is less common cause, this condition occurs when percutaneous intravascular coronary angioplasty (PCI) or thrombolytic therapy does not lead to restoration of blood supply. Pericarditis after pericardiotomy (postpericardiotomy syndrome) develops in 5-30% of all cardiosurgical interventions.

Causes of acute pericarditis

  • Idiopathic
  • Infectious
    • Virus (viruses of the ECHO group, influenza virus, group C Coxsack, HIV).
    • Bacterial (Streptococcus, Staphylococcus, Gram-negative bacteria, in children Haemophilus influenzae).
    • Fungal (histoplasmosis, coccidioidosis, candidiasis, blastomycosis).
    • Parasitic (toxoplasmosis, amebiasis, echinococcus)
  • Autoimmune (RA, SLE, systemic sclerosis)
  • Inflammatory (amyloidosis, inflammatory bowel disease, sarcoidosis)
  • Uremia
  • Injury
  • Myocardial infarction
  • Postinfarction syndrome (Dressler)
  • Medicinal (including due to the use of hydralazine, isoniazid, phenytoin, procainamide)

* If lymphoma develops in AIDS patients, Kaposi's sarcoma or certain infections (caused by Mycobacterium avium, mycobacterium tuberculosis, Nocardia, other fungal or viral infections), pericarditis is possible. Tuberculous pericarditis accounts for less than 5% of cases of acute or subacute pericarditis in the US, but causes the majority of cases in some areas of India and Africa.

Chronic pericardial effusion or constrictive pericarditis can result from almost any disease that causes acute pericarditis, as well as tuberculosis, swelling, irradiation and cardiac surgery. Sometimes the cause of chronic pericarditis remains unsettled. Pericarditis with a large effusion (serous, serous-hemorrhagic or hemorrhagic) is usually caused by metastatic tumors, most often by lung or breast cancer, sarcoma (especially melanoma), leukemia or lymphoma.

Fibrosis of the pericardium can be the result of purulent pericarditis, an infectious process in the myocardium (myocarditis is a common cause in young people) or connective tissue diseases. In elderly patients, frequent causes are malignant tumors, myocardial infarction and tuberculosis. Hemopericardium (accumulation of blood in the pericardial cavity) can lead to pericarditis or pericardial fibrosis; common causes are chest trauma, iatrogenic injury (for example, as a result of heart probing, pacemaker implantation or central venous access) and aneurysm rupture of the thoracic aorta.

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