Summary

Clinical features of pericarditis with and without myocardial involvement diagnosed in the emergency department and factors associated with need for hospitalization

Martínez-Nadal G, Prepoudis A, Miró O, Matas A, Cepas P, Aldea A, Izquierdo A, Alonso Viladot JR, Flores D, Gualandro DM, Müller C, López-Barbeito B

Affiliation of the authors

Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. The GREAT (Global Research on Acute Conditions Team) network, Roma, Italy. Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Spain. Servicio de Cardiología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.

DOI

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Quote

Martínez-Nadal G, Prepoudis A, Miró O, Matas A, Cepas P, Aldea A, et al. Clinical features of pericarditis with and without myocardial involvement diagnosed in the emergency department and factors associated with need for hospitalization. Emergencias. 2020;32:97-104

Summary

Objectives.

To analyze the clinical features of acute pericarditis diagnosed in the emergency department according to patient age and myocardial involvement (myopericarditis) and to determine factors associated with hospitalization.

Methods.

Retrospective, descriptive, observational, single-center study of consecutive patients. We analyzed all cases of pericarditis diagnosed in the emergency department over a period of 10 years (2008–2017), reviewing clinical, electrocardiographic, and laboratory findings as well as ultrasound imaging for myocardial involvement. Characteristics

were analyzed by age (under 50 years or 50 or older) and presence or not of myocardial involvement. Factors associated with hospitalization for both pericarditis and myopericarditis were identified by crude and adjusted odds ratios (ORs).

Results.

A total of 983 patients were diagnosed with pericarditis (34% women, mean age, 42 years). The younger patients more often reported sharp chest pain modified by breathing or posture changes. Older patients had more concurrent cardiovascular disease and described chest pain as pressure (oppressive); acute coronary syndrome was

suspected more often in the older patients. The only independent predictor of myopericarditis was a finding of electrocardiographic abnormalities, recorded in 72 cases (7%) (OR, 4.26; 95% CI, 1.89–9.59). Sixty-two patients (6%) were admitted for pericarditis. Associated factors were renal insufficiency (OR, 4.83; 95% CI, 1.66–14.05), pain

modified by breathing or posture changes (OR, 0.54; 95% CI, 0.29–0.99), tachycardia (OR, 2.29; 95% CI, 1.15–4.55), and myopericarditis (OR, 8.73; 95% CI, 4.65–16.38). Admission of 24 patients (33%) for myocarditis was related to focused cardiac ultrasound findings (OR, 13.72; 95% CI, 1.80–104).

Conclusions.

Age may affect the presentation of pericarditis. ST segment abnormalities on an electrocardiogram suggest myocardial involvement. Renal insufficiency, tachycardia, and myocardial involvement are the factors associated with a decision to admit patients with pericarditis. Ultrasound findings are associated with admission for myopericarditis.

 

More articles by the authors

Aldea A, Alonso Viladot JR, Cepas P, Flores D, Gualandro DM, Izquierdo A, López-Barbeito B, Martínez-Nadal G, Matas A, Miró O, Muller C, Prepoudis A

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