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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The most common cause (up to about 80 %) of pericarditis is idiopathic, meaning the reason cannot be determined. However, listed below are some known causes of pericarditis.

Infections may cause inflammation of the pericardium and viruses such as the Coxsackie B, adenovirus and influenza A and B are most common.

Other viruses can be involved, examples include:

• Epstein-Barr virus that causes infectious mononucleosis,
  
  
• herpes simplex type 1,
  
  
• measles,
  
  
• mumps, and
  
  
• human immunodeficiency virus (HIV).

Even less commonly, bacterial infections such as tuberculosis may cause pericarditis and often bacterial infections are associated with the development of constrictive pericarditis (see below). Other infectious causes include parasites and fungi.

Illnesses that can cause generalized inflammation in the body can also cause inflammation of the pericardium. Examples of these may include:

• rheumatoid arthritis,
  
  
• systemic lupus erythematosus,
  
  
• scleroderma, and
  
  
• sarcoidosis.

Other illnesses may contribute or cause pericarditis and examples include:

• Kidney disorders including patients on chronic dialysis.
  
  
• Patients having a heart attack can develop pericardial inflammation because of the underlying heart muscle damage. This may occur within days of the heart attack or may be delayed by 2-3 weeks. Dressler's syndrome describes delayed pericarditis after heart attack or heart surgery. It may be associated with lung inflammation and effusion (fluid accumulation).
  
  
• Hypothyroidism or decreased thyroid function may be associated with pericardial inflammation.
  
  
• Cancers and other malignancies can be associated with pericarditis. The pericardium can be inflamed by direct extension of cancer cells from nearby structures or there can be hematogenous spread of abnormal cancer cells through the blood stream. Lung cancer, breast cancer, leukemia and lymphoma, both Hodgkin's and non-Hodgkin's are the common cancer causes of pericarditis.

• Trauma that injures the heart can cause inflammation of the pericardium. The injury can be a direct blow to the chest causing a cardiac contusion or it can be a penetrating injury to the chest and heart.
  
  
• Radiation cancer therapy can cause inflammation of the pericardium.
  
  
• Pericarditis can be an uncommon side effect of some medications. Examples include some cancer chemotherapy medications, a few heart medications (for example, procainamide [Procan SR, Procanbid, Pronestyl, Pronestyl-SR], hydralazine [Apresoline], phenytoin [Dilantin, Dilantin Infatabs, Dilantin Kapseals, Dilantin-125, Phenytek, Phenytoin Sodium Prompt]) and smallpox vaccine (Dryvax).

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