- Yehuda Adler, MD
Yehuda Adler, MD
- Professor of Cardiology
- Cardiac Rehabilitation Institute
- Tel Aviv University, Israel
- Massimo Imazio, MD, FESC
Massimo Imazio, MD, FESC
- Contract Professor of Physiology
- University Cardiology, AOU Città della Salute e della Scienza di Torino and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Section Editors
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
- Jae K Oh, MD
Jae K Oh, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
Recurrent pericarditis is a common and often vexing problem for specialists in pericardial disease as well as general internists and family clinicians. The term refers to a syndrome in which acute pericarditis recurs after the agent inciting the original acute attack has disappeared or has ceased to be active.
Recurrent pericarditis, including its definition, proposed pathogenesis, clinical manifestations, diagnosis, and treatment, will be reviewed here. The clinical manifestations, diagnosis, and treatment of patients with an initial attack of acute pericarditis are discussed separately. (See "Clinical presentation and diagnostic evaluation of acute pericarditis" and "Treatment of acute pericarditis".)
The major clinical manifestations of acute pericarditis are chest pain, pericardial friction rub, widespread saddle-shaped or concave upward ST segment elevation on the electrocardiogram (ECG), and pericardial effusion . At least two of these features should usually be present to make the diagnosis. The clinical manifestations of acute pericarditis are discussed in greater detail elsewhere. (See 'Clinical presentation' below and "Clinical presentation and diagnostic evaluation of acute pericarditis", section on 'Clinical features'.)
Recurrent pericarditis is manifested by recurrence of the symptoms of acute pericarditis (table 1); however, the predominant feature of recurrent pericarditis is usually chest pain, and other clinical manifestations of acute pericarditis may not be present. The term recurrent pericarditis refers to a syndrome in which acute pericarditis recurs after the agent inciting the original acute attack has disappeared or has ceased to be active [2-5]. The recurrence of symptoms can be at any point following the prior cessation of acute pericarditis symptoms, but usually occurs weeks to months later. Generally there is an arbitrary defined period of six weeks from the initial or previous attack. Cases with incessant or persistent symptoms within six weeks are considered "incessant pericarditis" rather than "recurrent pericarditis."
The COlchicine for REcurrent pericarditis (CORE) trial, which enrolled 120 patients with recurrent pericarditis to evaluate colchicine therapy, required patients to have both of the following clinical criteria to meet their definition of recurrent pericarditis :
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- Scardapane A, Brucato A, Chiarelli F, Breda L. Efficacy of an interleukin-1β receptor antagonist (anakinra) in idiopathic recurrent pericarditis. Pediatr Cardiol 2013; 34:1989.
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- Jain S, Thongprayoon C, Espinosa RE, et al. Effectiveness and Safety of Anakinra for Management of Refractory Pericarditis. Am J Cardiol 2015; 116:1277.
- Brucato A, Imazio M, Gattorno M, et al. Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence: The AIRTRIP Randomized Clinical Trial. JAMA 2016; 316:1906.
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- CLINICAL PRESENTATION
- Intensity of symptoms
- Time course and frequency of recurrences
- Predictors of recurrence
- Laboratory and diagnostic testing findings
- - Electrocardiogram
- - Chest x-ray and echocardiogram
- - Signs of inflammation
- - Pericardial inflammation by imaging (CT and CMR)
- Communication with the patient
- Activity restriction
- Nonsteroidal antiinflammatory drugs
- - Our approach to glucocorticoid use
- - Intrapericardial steroids
- Other immune therapy
- Recurrent pain without objective evidence of disease
- Role of pericardiectomy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS