Cardiologia

The

new england journal

of

medicine

clinical practice

Acute Pericarditis
Richard A. Lange, M.D., and L. David Hillis, M.D.
This Journal feature begins with a case vignettehighlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinicalrecommendations.

A 35-year-old woman who is otherwise healthy has had constant retrosternal chest pain for two days. The pain becomes worse when she lies down and improves when she sits up and leansforward. On physical examination, the patient is afebrile and has a friction rub. The 12-lead electrocardiogram shows widespread ST-segment elevation and concomitant PR-segment depression. How should thepatient be evaluated and treated?

the clinical problem
The fibrous pericardium surrounding the heart is composed of visceral and parietal layers separated by the pericardial cavity, which normallycontains 15 to 50 ml of strawcolored fluid. Acute pericarditis may occur as an isolated entity or as the result of a systemic disease. The incidence of pericarditis in postmortem studies ranges from 1percent to 6 percent, whereas it is diagnosed ante mortem in only 0.1 percent of hospitalized patients and in 5 percent of patients seen in emergency rooms with chest pain but without myocardialinfarction.1,2 The possible sequelae of pericarditis include cardiac tamponade,3,4 recurrent pericarditis,5,6 and pericardial constriction.7-11
From the Department of Internal Medicine, CardiologyDivision, Johns Hopkins Medical Institutions, Baltimore (R.A.L.); and the University of Texas Southwestern Medical Center, Dallas (L.D.H.). Address reprint requests to Dr. Hillis at Rm. G5.232, University ofTexas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9030, or at dhilli@parknet.pmh.org. N Engl J Med 2004;351:2195-202.
Copyright © 2004 Massachusetts Medical Society....