How is acute pericarditis classified?

Written by Chen Tian Hua
Cardiology
Updated on March 11, 2025
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Acute pericarditis is classified according to the course of the disease, including acute fibrinous pericarditis and acute exudative pericarditis. If classified according to the cause, it can be divided into infectious pericarditis and non-infectious pericarditis. Infectious pericarditis can be caused by viruses, bacteria, tuberculosis, fungi, etc., while non-infectious pericarditis can be seen in tumors, uremia, acute myocardial infarction, aortic dissection, connective tissue disease, trauma, and cardiac surgery, etc.

Acute pericarditis is an acute inflammatory disease of the pericardium's parietal layer, and its occurrence requires timely diagnosis. It is also important to further clarify the specific cause of acute pericarditis and actively treat it.

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Constrictive pericarditis causes hepatomegaly.

The so-called constrictive pericarditis refers to the presence of fibrotic calcifications and fibrotic hyperplasia in the pericardium, which severely affects the diastolic function of the heart. Once the diastolic function of the heart is compromised, the return flow of venous blood becomes severely obstructed, leading to congestion of the liver. Therefore, once congestion of the liver and spleen occurs, enlargement of the liver can occur, and in severe cases, it can lead to systemic edema, including ascites and similar conditions. Thus, the basic principle behind the enlargement of the liver in constrictive pericarditis is as such. Especially in such cases, patients will experience severe dietary problems, including poor appetite and indigestion, which further lead to low protein levels and malnutrition, exacerbating the enlargement of the liver and edema.

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Early symptoms of acute pericarditis

The early symptoms of acute pericarditis are pain, which is located behind the sternum or in the precordial area, typically seen in the fibrin exudative type of inflammation. This pain arises from the friction between the visceral pericardium and the parietal pericardium. The nature of the pain is very sharp and related to respiratory movement, commonly exacerbated by coughing, deep breathing, or swallowing. The pain can radiate to the neck, left shoulder, and left arm. As fluid accumulates in the pericardium and the two layers of the pericardium separate, the pain may decrease or disappear.

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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.

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Can acute pericarditis be cured?

Patients with acute pericarditis should identify the cause of pericarditis and treat accordingly, rest in bed until chest pain and fever subside, administer analgesics for pain relief, and if pericardial effusion occurs, administer corticosteroids for patients who do not respond well to other medications for absorbing effusion. In cases of excessive pericardial effusion leading to acute cardiac tamponade, immediate pericardiocentesis and fluid drainage are necessary. For persistent recurrent pericarditis lasting over two years, and in patients who cannot be controlled with steroids, or those with severe chest pain, surgical pericardiectomy may be considered as a treatment option.

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Tuberculous pericarditis differential diagnosis

The differential diagnosis of tuberculous pericarditis requires differentiation from other types of pericardial inflammation, such as bacterial pericarditis and nonspecific infections that lead to cellular inflammation of the pericardium. In addition to infections that can cause pericarditis, other infectious diseases such as subacute endocarditis and infections caused by other microbes can also lead to pericarditis. Furthermore, some rheumatic autoimmune diseases can also present with pericarditis. It is necessary to perform pericardiocentesis and fluid examination to determine the specific cause.