What is Pericarditis?
Pericarditis is the inflammation and swelling of the thin saclike tissue known as the pericardium, which encases the heart. This condition can lead to sharp shooting chest pain stemming from the friction of irritated pericardium. While mild pericarditis often resolves on its own without medical intervention, more severe instances may necessitate treatment with medications or, in rare cases, surgical intervention. Timely diagnosis and appropriate treatment are crucial in mitigating the potential long-term complications associated with pericarditis.
What are the types of pericarditis?
- Acute pericarditis
- Recurrent pericarditis may occur 4-6 weeks after the first episode of acute pericarditis with no symptoms in the interim.
- Incessant pericarditis manifests with continuous symptoms lasting 4-6 weeks.
- Chronic pericarditis refers to inflammation of the pericardium, persisting for three months or more following the first episode.
- Constrictive pericarditis is an advanced-stage pericarditis characterized by the stiffening, scarring, thickening, and adherence of inflamed pericardial layers. This condition interferes with the normal functioning of the heart and typically arises following repeated episodes of acute pericarditis over time.
- Infectious pericarditis stems from an infection caused by viruses, bacteria, fungi, or parasites.
- Idiopathic pericarditis occurs without a known cause.
- Traumatic pericarditis develops due to chest injuries from a car accident.
- Uremic pericarditis is due to kidney failure.
- Malignant pericarditis is secondary to cancerous growth.
What causes pericarditis?
- Infections, particularly viral infections
- Previous chest radiation for treating breast cancer, lung cancer, or lymphoma
- Chest trauma from a steering wheel injury or a bullet or knife wound. An invasive cardiac procedure or myocardial infarction can damage the heart muscle, leading to pericarditis. In rare cases, cardiopulmonary resuscitation (CPR) can also cause trauma to the heart that induces pericarditis
- Drugs and toxins
- Metabolic disorders such as kidney failure
- Lung cancer, breast cancer, or Hodgkin lymphoma
- Rheumatoid arthritis, systemic lupus erythematosus, scleroderma, mixed connective tissue disease, systemic vasculitides, and familial Mediterranean fever.
- Ulcerative colitis or Crohn's disease
Determining the cause of pericarditis can be challenging. In numerous instances, the underlying cause of pericardial disease remains unknown. Identifying the cause is not always essential, particularly if the condition responds positively to empiric anti-inflammatory treatment, such as aspirin or ibuprofen.
What are the symptoms of pericarditis?
Symptoms may vary depending on the type of pericarditis.
- Chest pain. Some people may feel sharp or stabbing chest pain, while others experience dull and pressure-like chest pain.
- Pain behind the breastbone or on the left side of the chest that spreads to the left shoulder and neck worsens when coughing, taking a deep breath, lying down, or improving when leaning forward or sitting up.
- Coughs
- Fatigues
- Low-grade fever
- Heart palpitations
- Swelling in the leg and abdomen
- Shortness of breath when lying supine
When to see a doctor?
If you experience chest pain, seeking a thorough diagnosis is advised, as symptoms of pericarditis may resemble those of heart and lung conditions.
What are the complications of pericarditis?
- Pericardial effusion can lead to further heart complications.
- Constrictive pericarditis can cause significant swelling of the legs and abdomen, along with shortness of breath.
- Cardiac tamponade is a critical condition that impedes proper heart filling, leading to reduced cardiac output and a significant drop in blood pressure. This life-threatening situation necessitates immediate emergency intervention.
What are the diagnostic methods for pericarditis?
- History taking and physical exam. During a physical examination, your doctor will use a stethoscope to listen for a distinct sound known as a pericardial rub. ‘
- Blood tests to check for heart attack, inflammation, and infection.
- Chest X-ray to assess the heart size and detect any presence of fluid in the lungs.
- Electrocardiogram (ECG or EKG) to check your heartbeat. People with pericarditis usually have some changes in their EKG.
- An echocardiogram (ECHO) can determine the function of your heart and check for a pericardial effusion. It can help detect constrictive pericarditis.
- Cardiac MRI can detect excess fluid in the pericardial sac, inflammation, or thickening of the pericardium. A gadolinium contrast can help to enhance the quality of the image.
- A CT scan can check calcium deposits in the pericardium, fluid accumulation in the pericardial sac, inflammation, tumors, and diseases affecting the organs surrounding the heart. This test is crucial for patients who may require surgery for constrictive pericarditis.
- Cardiac catheterization to check the filling pressures in the heart. It can help confirm constrictive pericarditis.
What are the treatment options for pericarditis?
The treatment approach for pericarditis varies based on the underlying cause and the severity of symptoms. Mild pericarditis can improve without treatment.
- Medications can relieve swelling and inflammation.
- Pain relievers, including ibuprofen or aspirin
- Colchicine can decrease inflammation. It is effective for acute or incessant pericarditis. However, always consult with your doctor before taking colchicine, as it can interact with other drugs. People with liver or kidney disease should not take colchicine.
- Corticosteroids may be necessary if your symptoms recur or do not improve with other drugs.
- Antibiotics may be prescribed for pericarditis caused by a bacterial infection. Drainage of pericardial sac fluid may also be necessary.
- Surgeries or other procedures
- Pericardiocentesis
- Pericardiectomy involves the surgical removal of the entire pericardium before it becomes permanently rigid from constrictive pericarditis.
How long does it take for recovery after treatments?
Medications should improve your symptoms within one or two weeks. Postoperative recovery can take weeks or months. While recovering, refrain from engaging in strenuous physical activities or sports as they can trigger pericarditis symptoms.
How can you prevent pericarditis?
- Practice good hygiene by maintaining regular hand-washing habits, which can prevent the spread of infectious agents.
- Avoid people with viral or flu-like illnesses.
- Get the recommended vaccines, such as COVID-19, rubella, and influenza, which can prevent diseases causing myocarditis. While rare, the COVID-19 vaccine may lead to myocarditis, particularly among males aged 12 through 17. You can discuss the advantages and potential risks before vaccination with your doctor.
What should you do before seeing your doctor?
- Write down your symptoms and medications and dietary supplements you are taking.
- Write down questions you would like to ask your doctor, such as
- What causes pericarditis?
- Do I need to undergo additional tests?
- What treatment options do you recommend? Are there any side effects?
- When will my symptoms improve?
- What are the complications of pericarditis?
- Are there any exercise or diet restrictions I need to follow?
- Prepare answers for the questions that your doctor may ask, such as
- Where do you feel the pain? Is the pain severe?
- What are your symptoms? When did you first develop them?
- Do your symptoms come and go?
- Do you have shortness of breath?
- Does your symptoms improve when you change your position?
- Have you had a fever recently?
- Do you have a family history of pericarditis?
- Do you smoke?
- Have you lost weight with no known causes?
A note from MedPark’s doctors
Prompt treatment for pericarditis typically leads to a complete recovery. Strictly following your treatment regimen can reduce the likelihood of recurrence. It is crucial to continue taking prescribed medications and attend all follow-up appointments.
