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What causes pericarditis?
Last reviewed: 06.07.2025
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Acute pericarditis occurs as a result of an 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 may accompany infective endocarditis, pneumonia, sepsis, and occur with infection as a result of trauma or cardiac surgery. Often the cause cannot be identified (nonspecific, or idiopathic, pericarditis), but many of these cases probably have a viral etiology. In general, viral and idiopathic pericarditis are diagnosed most often. Acute myocardial infarction causes 10-15% of cases of acute pericarditis. Post-infarction syndrome (Dressler syndrome) is a less common cause, and occurs when percutaneous coronary angioplasty (PCA) or thrombolytic therapy fail to restore blood flow. Pericarditis following pericardiotomy (post-pericardiotomy syndrome) occurs in 5-30% of all cardiac surgeries.
Causes of acute pericarditis
- Idiopathic
- Infectious
- Viral (ECHO group viruses, influenza virus, Coxsackie group B, HIV).
- Bacterial (streptococci; staphylococci; gram-negative bacteria; in children Haemophilus influenzae).
- Fungal (histoplasmosis, coccidioidomycosis, candidiasis, blastomycosis).
- Parasitic (toxoplasmosis, amoebiasis, echinococcus)
- Autoimmune (RA, SLE, systemic sclerosis)
- Inflammatory (amyloidosis, inflammatory bowel disease, sarcoidosis)
- Uremia
- Injury
- Myocardial infarction
- Post-infarction syndrome (Dressler's)
- Medicinal (including due to the use of hydralazine, isoniazid, phenytoin, procainamide)
*If patients with AIDS develop lymphoma, Kaposi's sarcoma, or certain infections (Mycobacterium avium, tuberculosis, Nocardia, other fungal or viral infections), pericarditis may occur. Tuberculous pericarditis accounts for less than 5% of cases of acute or subacute pericarditis in the United States, but causes the majority of cases in parts of India and Africa.
Chronic pericardial effusion or constrictive pericarditis may result from almost any disorder that causes acute pericarditis, as well as tuberculosis, tumor, radiation, and cardiac surgery. Sometimes the cause of chronic pericarditis remains unknown. Pericarditis with a large effusion (serous, serosanguineous, or hemorrhagic) is usually caused by metastatic tumors, most commonly lung or breast cancer, sarcoma (especially melanoma), leukemia, or lymphoma.
Pericardial fibrosis may result from purulent pericarditis, myocardial infection (myocarditis is a common cause in young people), or connective tissue disease. In older patients, common causes are malignancies, myocardial infarction, and tuberculosis. Hemopericardium (accumulation of blood in the pericardial space) may lead to pericarditis or pericardial fibrosis; common causes include chest trauma, iatrogenic injury (eg, from cardiac catheterization, pacemaker implantation, or central venous access), and ruptured thoracic aortic aneurysm.