Pericarditis is an inflammation of the pericardium - the sack-like membrane that contains the heart. In most cases, the illness will pass without medical intervention.
In roughly 90% of patients, the cause of pericarditis is not known, but it can be infectious or noninfectious and is the most common disease of the pericardium.1
In this article, we will discuss pericarditis' causes and symptoms and the interventions used to treat it.
Contents of this article:
- What is pericarditis?
- Symptoms of pericarditis
- Causes of pericarditis
- Tests and diagnosis of pericarditis
- Treatment of pericarditis
Here are some key points about pericarditis. More detail and supporting information is in the main article.
- Pericarditis is a swelling of the pericardium, a sack-like tissue that contains the heart.
- Pericarditis can have a number of causes, including bacterial or viral infection, parasites or fungus.
- Most commonly, pericarditis is due to a virus.
- In general, pericarditis will disappear on its own without treatment.
- Symptoms of pericarditis include palpitations, a dry cough and pain in the shoulder.
- There are a series of imaging tests that are used to diagnose the illness.
- Tuberculosis is the biggest cause of pericarditis worldwide.
- In rare cases, pericarditis can permanently scar the pericardium.
- Colchicine is currently one of the most effective treatments.
What is pericarditis?
Pericarditis is an inflammation of the pericardial sac.
Pericarditis is an inflammation of the pericardium. The swelling causes a sharp pain as the affected pericardial layers rub together and irritate.2
In general, pericarditis starts quickly and does not last particularly long - this is known as acute pericarditis. Often, the illness will pass with little intervention. If pericarditis lasts for a longer period of time, it is referred to as chronic pericarditis.
Chronic pericarditis is further split into two categories:
- Incessant: occurs within 6 weeks of weaning medical treatment for acute pericarditis
- Intermittent: occurs after 6 weeks of weaning medical treatment for acute pericarditis.
Some clinicians further split pericarditis down into five groups, depending on the type of fluid that accumulates around the heart:
- Serous: pale, yellow transparent fluid
- Purulent: white-yellow pus
- Fibrinous: consists of fibrin (a blood clotting agent) and leukocytes (white blood cells)
- Caseous: caseous necrosis is a form of cell death; affected tissue develops a cheese-like appearance
- Hemorrhagic: blood-based fluid.
Symptoms of pericarditis
The symptoms of pericarditis can include the following:
- Sharp pain in the chest, sometimes central, other times to the left; may decrease in intensity when sitting up and leaning forward
- Shortness of breath, especially when reclining
- Minor fever
- General weakness
- Swelling of the abdomen or legs
- Pain in the shoulder.
The symptoms are very similar to a heart attack. It is imperative to seek medical attention if you experience chest pain. A doctor can then rule out less serious conditions and perhaps investigate the reasons for the pericarditis.
Complications of pericarditis
- Cardiac tamponade: if too much fluid builds up in the pericardium it can put additional pressure on the heart, preventing it from fully filling with blood - this can cause a fatal drop in blood pressure if left untreated
- Constrictive pericarditis: a rare byproduct of pericarditis. Constrictive pericarditis involves a permanent thickening and scarring of the pericardium. This causes a hardening of the tissues and restricts the heart from working properly, potentially leading to swelling in the feet and legs and shortness of breath.
Causes of pericarditis
The pericardial sac, or pericardium, consists of two layers, separated by a small amount of fluid. This fluid keeps the movement between the two membranes smooth.
If the pericardium becomes infected and swells, the two layers will come into contact, causing friction.
In around 90% of cases, the primary cause of pericarditis cannot be found - it is therefore referred to as idiopathic pericarditis.3 Many cases are assumed to be caused by viral infections that cannot be detected.
Pericarditis is most often caused by a viral infection.
The following viruses are associated with acute pericarditis:
- Enteroviruses, including the common cold and viral meningitis
- Glandular fever
- Herpes simplex
- Adenoviruses including pneumonia and bronchitis
- Hepatitis C.
Pericarditis often arrives soon after a major heart attack. This is thought to be due to irritation of the underlying heart muscles. Similarly, pericarditis can occur after heart surgery.
Sometimes, pericarditis will occur weeks after a heart attack or operation. This is known as Dressler's syndrome. In this case, the cause is likely to be autoimmune.
Researchers believe that necrotic (dead) heart tissue enters the blood system and acts as an antigen, triggering an immune reaction. The body mistakenly reacts against the tissues of the heart and pericardium.4
Other causes of pericarditis include:
- Systemic inflammatory disorders: including rheumatoid arthritis or lupus
- Trauma: serious injuries in the chest area can bring on the condition
- Kidney failure: the reasons for this connection remain unclear
- Parasite: parasitic pericarditis can be caused by, for instance, Chagas' disease5
- Radiotherapy: radiation can damage the pericardial tissue
- Fungus: fungal pericarditis is rarer than other forms, but histoplasmosis, Candida and other fungi are known to cause an inflamed pericardium
- Existing conditions: e.g., AIDS, cancer and tuberculosis. Tuberculosis is the biggest cause of pericarditis worldwide
- Underactive thyroid: the reasons for this connection remain unclear
- Certain medications: rarely, some drugs can cause pericarditis, including penicillin, warfarin and phenytoin.6
Tests and diagnosis of pericarditis
Initially, a doctor will listen to the patient's chest. As the pericardial layers rub together, they can make a distinctive sound.
Further tests will be used to check if there has been a heart attack, if fluid has amassed in the pericardial sac or if there are any signs of inflammation.
The following diagnostic tools may be used:
- Chest X-ray: an X-ray will show up the shape of the heart, indicating whether it has enlarged due to excess fluid
- Computerized tomography (CT): CT can produce a more detailed image of the heart than standard X-rays and can rule out other possible problems such as pulmonary clots and aortic tears
- Cardiac magnetic resonance imaging (MRI): using radio waves and magnetic fields, this technique builds up an accurate picture of the width of the heart walls
- Echocardiogram: builds up a detailed image of the heart using sound waves
- Electrocardiogram (ECG): patches and wires are applied to the chest to measure the electrical activity of the heart.
Treatment of pericarditis
In most cases of pericarditis, the condition will not need treating.
The way in which pericarditis is treated depends on its severity and underlying causes. In milder cases, a course of no action may be chosen as the illness commonly clears up of its own accord.
If treatment is necessary, the first line of defense is medication:
- Over-the-counter pain medicine: without a prescription, drugs such as aspirin or ibuprofen can ease much of the pain and inflammation experienced in pericarditis. Prescription-strength painkillers might also be utilized if necessary
- Colchicine (Colcrys): if the pericarditis is particularly painful or recurrent, colchicine might be prescribed. This drug, with anti-inflammatory effects, can minimize the duration and prevent recurrence. However, many people with existing conditions, such as liver or kidney disease, will be advised against taking it. Side effects include abdominal pain, vomiting and diarrhea
- Corticosteroids: if neither of the first two actions have worked, corticosteroids may be employed. Research has shown, however, that if steroids are given during the first attack of pericarditis, the patient is six times more likely to have a relapse; for this reason, they are the last port of call. Side effects include weight gain, mood swings and increased sweating.
- Pericardiocentesis: a small tube is inserted into the pericardial cavity to drain excess fluid. The tube might be left inserted for several days
- Pericardiectomy: if the pericardium has become particularly rigid and is causing the heart additional stress, the entire sac might be removed surgically. This is very much a last resort; there is a 5% risk of the operation causing death.
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