Características clínicas de las pericarditis y miopericarditis diagnosticadas en urgencias y factores asociados con la necesidad de hospitalización

espanolObjetivo. Analizar los episodios de pericarditis aguda (PA) diagnosticados en urgencias en funcion de la edad y de la afectacion miocardica (miopericarditis, MioP), y determinar los factores asociados a hospitalizacion. Metodo. Estudio observacional, descriptivo, unicentrico de casos consecutivos, con analisis retrospectivo de todos los casos diagnosticados de PA en urgencias durante 10 anos (2008-2017), y revision de las caracteristicas clinicas, ECG, analiticas y ecograficas (en MioP). Se compararon caracteristicas clinicas segun la edad ( Resultados. Se diagnosticaron 983 PA (34% mujeres, mediana de edad: 42 anos). Los pacientes mas jovenes referian con mayor frecuencia dolor toracico (DT) punzante y modificable con la respiracion o cambios posturales, y los mas mayores tenian mas comorbilidades cardiovasculares, refirieron mas frecuentemente DT opresivo y generaron mayor sospecha de sindrome coronario agudo. Las alteraciones en el ECG (OR = 4,26; IC95% = 1,89-9,59) se asociaron a MioP (72 casos, 7%). Ingresaron 62 PA (6%), hecho asociado a antecedente de insuficiencia renal (OR = 4,83; IC95% = 1,66-14,05), DT que se modifica con movimientos respiratorios/posturales (OR = 0,54, IC95% = 0,29-0,99), taquicardia (OR = 2,29, IC95% = 1,15-4,55) y MioP (OR = 8,73, IC95% = 4,65-16,38). Ingresaron 24 MioP (33%), hecho asociado a alteraciones en la ecoscopia dirigida (protocolo FOCUS; OR = 13,72, IC95% = 1,80-104). Conclusiones. La edad puede condicionar la presentacion clinica en los pacientes con PA. Las alteraciones en el segmento ST en el ECG son sugestivos de implicacion miocardica. La insuficiencia renal, la taquicardia y la MioP son factores que incrementan la decision de hospitalizacion en las PA; mientras que en las MioP, las alteraciones ecograficas. EnglishObjectives. 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.