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Neue Möglichkeiten der Diagnostik und Therapie der Perikarditis

New possibilities of diagnostics and therapy of pericarditis

  • Schwerpunkt: Entzündliche Herzerkrankungen
  • Published:
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Zusammenfassung

Die Perikarditis ist eine Entzündung des Perikards mit oder ohne Ergussbildung. Die Diagnose stützt sich auf das klinische Bild und die typischen EKG-Veränderungen. Die Echokardiographie ist essenziell zum Nachweis und zur Beurteilung der hämodynamischen Relevanz des Ergusses. Eine Aufklärung der Ätiologie ermöglicht in vielen Fällen die Perikardpunktion und Perikardioskopie mit gezielter Biopsie und anschließender molekularbiologischer, immunologischer, zytologischer und mikrobiologischer Untersuchung des Ergusses und der Biopsate. Die antiinflammatorische Behandlung basiert auf nicht-steroidalen Antiphlogistika und/oder Colchizin. Die systemische Gabe von Kortikoiden wird bei unklarer Ätiologie kontrovers beurteilt. Während bei viraler Perikarditis die Kortikoide zu Rezidiven führen dürften, ist ihr Einsatz bei systemischer Autoimmunerkrankung mit Perikarditis, bei der autoreaktiven Perikarditis und als ergänzende Therapie bei der tuberkulösen Perikarditis sinnvoll. Die intraperikardiale Gabe von Triamcinolon ist bei autoreaktiver Perikarditis sinnvoll, während bei neoplastischem Perikarderguss die Instillation von Cisplatin zur Vermeidung eines Frührezidivs führt.

Abstract

Pericarditis is an inflammatory disorder of the pericardium with or without an associated pericardial effusion. The diagnosis is based on the clinical manifestations and typical ECG changes. Echocardiography is essential to reveal the size of the pericardial effusion and to determine its hemodynamic significance. The precise etiology of pericarditis may be established by pericardiocentesis, pericardioscopy and targeted biopsy and consecutive pericardial fluid and biopsy analysis by molecular biology, cytology, microbiology and immunological techniques. Non steroidal anti-inflammatory drugs and/or colchicine are the mainstay of anti-inflammatory treatment of pericarditis. Systemic corticoid treatment should be restricted to patients with associated autoimmune disorder, relapsing pericarditis and as a complementary therapy in tuberculous pericarditis. In autoreactive pericarditis intrapericardial instillation of triamcinolone is effective with few side effects. In malignant pericarditis the intrapericardial administration of cisplatin prevents early recurrences.

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  1. Klinik für Innere Medizin, Schwerpunkt Kardiologie, Universitätsklinikum Giessen und Marburg, Baldingerstraße 1, 35033, Marburg, Deutschland

    B. Maisch & K. Karatolios

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  1. B. Maisch
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  2. K. Karatolios
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Correspondence to B. Maisch.

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Maisch, B., Karatolios, K. Neue Möglichkeiten der Diagnostik und Therapie der Perikarditis. Internist 49, 17–26 (2008). https://doi.org/10.1007/s00108-007-1961-3

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