Review: Acute and complicated inflammatory pericarditis – Mayo Clin Proc

The article provides a comprehensive review of current approaches to the diagnosis and management of inflammatory pericardial disease, with a particular focus on acute and complicated cases of pericarditis. Here’s a summary tailored for a medical audience:

Key Points:

1 – Epidemiology and Presentation:

– Acute pericarditis is relatively common, particularly among younger populations.

– It can be effectively managed in most cases but poses a significant risk of recurrence and morbidity if not properly treated.

– Presentations can vary, with chest pain being a predominant symptom, which improves upon leaning forward and worsens in the supine position.

2 – Diagnostic Evaluation:

– Diagnosis hinges on a combination of clinical signs (e.g., chest pain, pericardial rub), ECG changes, imaging findings, and laboratory markers (elevated CRP and white blood cell count).

– Multimodality imaging plays a critical role in diagnosis and management, including echocardiography, CT, and MRI to evaluate pericardial effusion and inflammation.

3 – Management Strategies:

– The treatment landscape has evolved with the introduction of targeted anti-inflammatory therapies and a more systematic approach to care.

– Management includes NSAIDs as first-line therapy, colchicine to reduce recurrence rates, and corticosteroids for severe cases. Recent advancements include the use of interleukin-1 receptor blockers for complicated cases.

– Pericardiectomy may be considered in chronic or recurrent cases that are refractory to medical management.

4 – Future Directions:

– Ongoing research is directed at improving diagnostic accuracy through advanced imaging techniques and refining treatment protocols to minimize recurrence and manage complicated cases effectively.

– The integration of novel biological agents and personalized medicine approaches is anticipated to enhance outcomes for patients with pericardial disease.

This article emphasizes the importance of a protocol-driven approach to the initial care, the use of targeted therapeutics based on individual patient profiles, and the integration of care pathways to manage acute and complicated pericarditis effectively.

Reference (link to free full-text):
Malik, A. A., Lloyd, J. W., Anavekar, N. S., & Luis, S. A. (2024). Acute and Complicated Inflammatory Pericarditis: A Guide to Contemporary Practice. Mayo Clinic Proceedings, 99(5), 795-811. https://doi.org/10.1016/j.mayocp.2024.01.012