Pericarditis is a medical condition characterized by inflammation of the pericardium, the thin sac-like membrane that surrounds and protects the heart. This inflammation can cause the layers of the pericardium to rub against each other, leading to chest pain and other symptoms. Understanding pericarditis is crucial because it can range from a mild illness that resolves on its own to a serious condition requiring urgent medical care.
What Is Pericarditis?
The pericardium is a double-layered membrane that encloses the heart, containing a small amount of lubricating fluid. This fluid allows the heart to move smoothly within the chest as it beats. When the pericardium becomes inflamed, this fluid may increase or the layers may become roughened, causing pain and sometimes fluid accumulation around the heart (pericardial effusion).
Pericarditis can be classified into three types based on duration:
Acute pericarditis: lasts less than six weeks.
Recurrent pericarditis: symptoms return after a symptom-free interval of weeks.
Chronic pericarditis: persists for more than three months.
Causes of Pericarditis
Pericarditis has many causes, but often the exact cause remains unknown. The most common known causes include:
Viral infections: These are the leading cause in developed countries, with viruses such as coxsackievirus, herpesvirus, and HIV implicated.
Bacterial infections: Tuberculosis is a common cause worldwide, especially in developing countries. Other bacteria like pneumococcus can also cause pericarditis.
Autoimmune diseases: Conditions like systemic lupus erythematosus and rheumatoid arthritis can cause inflammation of the pericardium.
Heart-related causes: Pericarditis may follow a heart attack (Dressler’s syndrome), heart surgery, or trauma to the chest.
Metabolic causes: Kidney failure (uremia) can lead to pericarditis.
Cancer: Certain cancers, especially breast and lung cancer, can affect the pericardium.
Medications and treatments: Some drugs (e.g., hydralazine, warfarin) and radiation therapy to the chest can cause pericarditis.
Other causes: Rarely, fungal infections, aortic dissection, and postpericardiotomy syndrome (after heart surgery) can be responsible. Vaccines have been very rarely linked to pericarditis in some cases.
Symptoms of Pericarditis
The hallmark symptom of pericarditis is sharp, stabbing chest pain. This pain is often:
- Sudden in onset
- Worsened by lying down, deep breathing, coughing, or swallowing
- Relieved by sitting up and leaning forward
Other common symptoms include:
- Fever and chills
- Weakness or fatigue
- Heart palpitations
- Shortness of breath
- Muscle aches
- Dry cough
- Nausea
On physical examination, a characteristic “pericardial friction rub” may be heard with a stethoscope, caused by the rubbing of inflamed pericardial layers.
Diagnosis
Diagnosis is based on clinical symptoms, physical examination, and tests such as:
Electrocardiogram (ECG) showing typical changes like widespread ST elevation.
Echocardiogram to detect fluid accumulation around the heart.
Blood tests to check for inflammation and to identify underlying causes.
Chest X-ray or CT scan if needed to assess the pericardium and surrounding structures.
Treatment of Pericarditis
Treatment depends on the cause and severity of pericarditis but generally aims to reduce inflammation, relieve pain, and prevent complications.
First-line Treatment
Rest: Patients are advised to avoid strenuous activity until symptoms improve.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or aspirin are commonly used to reduce inflammation and chest pain.
Colchicine: This prescription medication is often added to NSAIDs to decrease symptoms and reduce the risk of recurrence.
Additional Treatments
Corticosteroids: Used in cases where NSAIDs and colchicine are contraindicated or ineffective, especially in autoimmune-related pericarditis. Steroids are used cautiously due to risk of recurrence.
Antibiotics: If a bacterial infection is identified as the cause.
Hospitalization: Required for severe cases or when complications arise.
Treatment of Complications
Pericardial effusion and cardiac tamponade: May require pericardiocentesis, a procedure to drain excess fluid from around the heart.
Constrictive pericarditis: A rare but serious complication where the pericardium becomes thickened and scarred, restricting heart function. This may require surgical removal of the pericardium (pericardiectomy).
Prognosis and Follow-up
Most patients recover fully within weeks to a few months with appropriate treatment. However, pericarditis can recur in up to 30% of cases. Chronic or recurrent pericarditis may require long-term management and sometimes advanced therapies such as immunosuppressive drugs or surgery.
Patients should be monitored for potential complications and advised to seek medical care if symptoms worsen or recur.
Conclusion
Pericarditis is inflammation of the heart’s protective sac, most commonly caused by viral infections but also by other infectious, autoimmune, and systemic conditions. It typically presents with sharp chest pain that improves when sitting up.
Diagnosis involves clinical evaluation and imaging. Treatment focuses on reducing inflammation with NSAIDs and colchicine, with corticosteroids and other therapies reserved for refractory cases. While most cases resolve well, some may recur or lead to complications requiring more intensive treatment.
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