Etiologies of Acute Pericarditis

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• 急性心包炎（病毒性、細菌性、結核性或特發性起源）。
• 自身免疫性疾病。
• 心肌梗塞或心臟手術後。
• 尖銳或鈍性胸部創傷，包括心臟診斷或介入手術。
• 惡性腫瘤，特別是非心臟原發性腫瘤的轉移擴散。
• 縱隔輻射。
• 腎功能衰竭伴尿毒症。
• 粘液性水腫。
• 主動脈夾層延伸到心包。
• 藥物

Idiopathic (~90%)

• Most presumed to be undiagnosed viral etiologies
• 大多數被認為是未確診的病毒病因

Infectious (<5% can be confirmed infectious)

• Viral:
  • Coxsackie, Parvovirus B19, echo, adeno, EBV, VZV, HIV, influenza, SARS CoV-2
• Bacterial (from endocarditis, pneumonia, or s/p cardiac surgery):
  • S. pneumo, N. meningitidis, S. aureus, Borrelia (Lyme); TB
• Fungi:
  • Histo, Coccidio, Candida; Parasite: Entamoeba, Echino

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Non-infectious

Neoplastic (<10%)

• Common: metastatic (lung, breast, lymphoma, leukemia, RCC)
• Rare: primary cardiac & serosal tumors (mesothelioma)
• 常見：轉移性（肺、乳腺、淋巴瘤、白血病、腎細胞癌）
• 罕見：原發性心臟和漿膜腫瘤（間皮瘤）

Autoimmune

• Connective tissue diseases: SLE, RA, scleroderma, Sjögren’s
• Vasculitides: PAN, ANCA ⊕ (EGPA, GPA)
• Drug-induced: procainamide, hydralazine, inh, CsA

Uremia

~5–13% of Pts prior to HD; ~20% occurrence in chronic HD Pts

Cardiovascular

STEMI, late post-MI (Dressler’s syndrome), but rare in modern era; prox AoD; chest trauma/postpericardiotomy; PCI or EP complication

Radiation

40 Gy to mediastinum; acute or delayed; may be transudative

Effusion w/o pericarditis

HF (particularly R-sided as pericardial fluid drains into RA), cirrhosis, nephrotic syndrome, hypothyroidism, amyloidosis. Transudative.