Informação da revista
Vol. 38. Núm. 2.
Páginas 103-104 (Fevereiro 2019)
Baixar PDF
Mais opções do artigo
Vol. 38. Núm. 2.
Páginas 103-104 (Fevereiro 2019)
Editorial comment
DOI: 10.1016/j.repc.2019.02.003
Acesso de texto completo
Pericarditis: Characteristics of a pediatric population
Pericardite: Apresentação e características numa população pediátrica
José Carlos Areias
Pediatria e Cardiologia Pediátrica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Conteúdo relacionado
Rev Port Cardiol. 2019;38:97-10110.1016/j.repc.2018.05.017
Catarina Perez‐Brandão, Conceição Trigo, Fátima F. Pinto
Este item recebeu
Informação do artigo
Texto Completo
Baixar PDF
Texto Completo

Pericarditis is an inflammatory condition of the pericardium, mostly with a viral or autoimmune etiology. Idiopathic, presumed viral, causes are responsible for 80-90% of cases.1 Acute pericarditis may occur secondary to collagen vascular disease, cardiac surgery or drug therapy, as a manifestation of rheumatic fever, or in association with chronic renal failure and dialysis. However, worldwide, the most common cause of acute pericarditis is tuberculosis, due to its high frequency in developing countries, where it is often associated with human immunodeficiency virus infection.2

The diagnosis is based on clinical criteria, including chest pain, pericardial rub, high temperature, electrocardiographic and echocardiographic changes and, in some cases, pericardial effusion.1 In children, clinical recognition will depend heavily on the type and severity of the pericardial reaction. Of physical findings, a pericardial friction rub is pathognomonic of acute pericarditis. This is a scratching sound caused by abrading of inflamed pericardial surfaces with cardiac motion. However, in the presence of a large pericardial effusion the rub may disappear.

In children, the predominant symptom of acute pericarditis is precordial chest pain, frequently exacerbated by breathing, coughing or movement.

There are few characteristic radiographic findings, and these vary depending on the nature of the pericardial disease. If effusion is absent, the cardiac silhouette may be normal. In borderline cases, comparison with a previous radiograph can be helpful.3

Changes in the electrocardiogram associated with pericarditis depend on the effect of the injured pericardium on the underlying myocardium, and may include changes in the QRS complex, ST segment or T wave. In the initial stage of the disease the ST segment is elevated in most leads except for V1 and aVR, which often remain unaltered.

Cross-sectional echocardiography is the most important diagnostic technique. In pericardial effusion, echocardiography will show an echo-free space surrounding the heart. Tamponade caused by fluid accumulation may present with cardiac wall motion abnormalities.3

The treatment of pericarditis depends on its origin. Antibiotic therapy is used to treat bacterial pericarditis and other drugs are used according to the etiology. Treatment of pericardial tamponade includes drainage of the pericardial fluid in patients with hypotension or low cardiac output.

In this issue of the Journal, Perez-Brandão et al.4 review the clinical presentation and characteristics of a pediatric population with pericarditis, performing a retrospective analysis of children admitted to a pediatric cardiology unit with pericarditis between 2003 and 2015. In agreement with published studies, the predominant symptom of acute pericarditis was precordial chest pain, in 70% of the patients. Forty-eight percent of children presented with infectious pericarditis, and postpericardiotomy syndrome was diagnosed in five cases. Pericardiocentesis was performed in 12 patients, 11 of them with cardiomegaly identified on the chest X-ray. Seventeen children had myocarditis accompanied by viral pericarditis. A variety of symptoms ranging from mild to overt heart failure and shock were observed.

Treatment of viral pericarditis is predominantly symptomatic, including bed rest. Medical therapy may include nonsteroidal anti-inflammatory drugs and colchicine. In their review, the authors emphasize the use of colchicine as a useful drug in recurrent cases.

In conclusion, pericarditis in children is relatively rare. A judicious analysis of the clinical findings, treatment and follow-up are mandatory.

Conflicts of interest

The author has no conflicts of interest to declare.

M. Imazio, F. Gaita, M. LeWinter.
Evaluation and treatment of pericarditis: a systematic review.
JAMA, 314 (2015), pp. 1498-1506
M. Imazio, F. Gaita.
Acute and recurrent pericarditis.
Cardiol Clin, 35 (2017), pp. 505-513
P.A. Vignola, G.M. Pohost, G.D. Curfman, et al.
Correlation of echocardiographic and clinical findings in patients with pericardial effusion.
Am J Cardiol, 37 (1976), pp. 701-707
C. Perez-Brandão, C. Trigo, F.F. Pinto.
Pericardite – Apresentação e características numa população pediátrica.
Rev Port Cardiol, 38 (2019), pp. 97-101
Copyright © 2019. Sociedade Portuguesa de Cardiologia
Revista Portuguesa de Cardiologia

Receba a nossa Newsletter

Opções de artigo
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.