Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis.
The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive pericarditis. Medical treatment should be targeted at the cause of the disease as much as possible. However, the cause of pericardial diseases may be varied and depends on the prevalence of specific diseases (especially tuberculosis). The search for an etiology is often inconclusive, and most cases are classified as idiopathic in developed countries where tuberculosis is relatively rare, whereas a tuberculous etiology is often presumed in developing countries where tuberculosis is endemic. The aim of the present article is to review current medical therapy for pericardial diseases, highlighting recent significant advances in clinical research, ongoing challenges and unmet needs. Following a probabilistic approach, the most common causes are considered (idiopathic, viral, tuberculous, purulent, connective tissue diseases and neoplastic pericardial disease). In this article, the therapy of idiopathic and more common forms of infectious pericarditis (viral and bacterial) is reviewed.
Imazio
Massimo
M
Cardiology Department, Maria Vittoria Hospital, Torino, Italy. massimo_imazio@yahoo.it
Brucato
Antonio
A
Mayosi
Bongani M
BM
Derosa
Francesco Giuseppe
FG
Lestuzzi
Chiara
C
Macor
Antonio
A
Trinchero
Rita
R
Spodick
David H
DH
Adler
Yehuda
Y
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003078:Colchicine / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010493:Pericarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000821:virology; D010494:Pericarditis, Constrictive / Q000188:drug therapy / Q000382:microbiology / Q000821:virology; D010495:Pericarditis, Tuberculous / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D003078:Colchicine