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Perikarditt

Sist revidert:
Sist revidert av:


Definisjon:
Betennelse av perikard, oftest forårsaket av virusinfeksjon eller etter akutt hjerteinfarkt. Kan også forårsakes av systemsykdommer eller strålebehandling.
Forekomst:
Klinisk perikarditt er relativt sjelden, men funnet hos 1% i autopsimateriale
Symptomer:
Brystsmerter hos 95%, ofte intense og akutt innsettende, og kan stråle ut til skuldre, hals eller arm.
Funn:
Perikardiell gnidningslyd er typisk ved akutt perikarditt. Ved kronisk perikarditt kan det utvikles ødemer, halsvenestuvning og hepatomegali.
Diagnostikk:
EKG kan vise typiske forandringer. Ekko-kardiografi kan påvise fortykket perikard.
Behandling:
Akutt perikarditt behandles konservativt med observasjon og ev. inflammasjonsdempende behandling, og ev. aktiv kausal behandling. Kirurgisk behandling aktuelt ved kronisk perikarditt.
  • Bert Andersson, docent och överläkare, Kardiologkliniken, Sahlgrenska universitetssjukhuset, Göteborg (Medibas)
  1. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, published online 29 August 2015 . PMID: 26320112 PubMed  
  2. Khandaker MH, Espinosa RE, Nishimura RA, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85:572-93. PMID: 20511488 PubMed  
  3. Ariyarajah V, Spodick DH. Acute pericarditis: diagnostic cues and common electrocardiographic manifestations. Cardiol Rev. 2007;15(1):24–30.
  4. Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015;314(14):1498-1506. PubMed  
  5. Cacoub P, Marques C. Acute recurrent pericarditis: from pathophysiology towards new treatment strategy. Heart 2020. pmid:32238419 PubMed  
  6. Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med (Hagerstown). 2010;11:712-722. PMID: 20736783 PubMed  
  7. Ariyarajah V, Spodick DH. Acute pericarditis: diagnostic cues and common electrocardiographic manifestations. Cardiol Rev. 2007;15:24-30. PubMed  
  8. Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med 2016. PMID: 26542793 PubMed  
  9. Gamaza-Chulián S, León-Jiménez J, Recuerda-Núñez M, Camacho-Freire S, Gutiérrez-Barrios A, Vargas-Machuca JC. Cardiac troponin-T in acute pericarditis. J Cardiovasc Med (Hagerstown). 2014;15(1):68-72. PubMed  
  10. Imazio M. Acute pericarditis: Clinical presentation, diagnostic evaluation, and diagnosis. UpToDate, last updated Apr 16, 2021. UpToDate  
  11. Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart. 2018;104(9):725-731. PubMed  
  12. Imazio M, Brucato A, Cemin R, et al. Colchicine for recurrent pericarditis (CORP). A randomized trial. Ann Intern Med 2011; 155: 409-14. Annals of Internal Medicine  
  13. Wiysonge CS, Ntsekhe M, Thabane L, Volmink J, Majombozi D, Gumedze F, Pandie S, Mayosi BM. Interventions for treating tuberculous pericarditis. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD000526. DOI: 10.1002/14651858.CD000526.pub2 DOI  
  14. Virk SA, Chandrakumar D, Villanueva C, et al. Systematic review of percutaneous interventions for malignant perocardial effusion. Heart 2015. doi:10.1136/heartjnl-2015-307907 DOI  
  15. Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicenter, double-blind, placebo-controlled, randomised trial. Lancet 2014. doi:10.1016/S0140-6736(13)62709-9 DOI  
  16. Alabed S, Cabello JB, Irving GJ, et al. Colchicine for pericarditis. Cochrane Database Syst Rev. 2014;8:CD010652. doi: 10.1002/14651858.CD010652.pub2 DOI  
  17. Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol. 2007;118(3):286–294.
  18. Wu K. Pericarditis. BestPractice. Last updated Aug 13, 2015.
  19. Imazio M, Andreis A, Piroli F, et al. Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis. Heart 2021. pmid:33737453 PubMed  
  20. Lotrionte M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am Heart J. 2010;160(4):662–670.
  • Ingard Løge, spesialist allmennmedisin, redaktør Norsk Elektronisk Legehåndbok (NEL)