Pericarditis

• Pericarditis is the inflammation of the pericardium, the protective sac around the heart.
• Common symptoms include sharp chest pain, often relieved by leaning forward, and fever.
• Viral infections are the most frequent cause, but other factors like autoimmune diseases or trauma can also contribute.
• Diagnosis involves physical examination, ECG, echocardiogram, and blood tests.
• Treatment typically includes anti-inflammatory medications, rest, and addressing the underlying cause.

What is Pericarditis?

Pericarditis refers to the inflammation of the pericardium, a thin, fluid-filled sac that encases the heart. This sac consists of two layers: a fibrous outer layer and a serous inner layer, with a small amount of fluid in between that allows the heart to beat without friction. When the pericardium becomes inflamed, these layers can rub against each other, causing pain and potentially impairing the heart’s function.

The condition can manifest in several forms. Acute pericarditis is the most common, characterized by a sudden onset of symptoms that typically last for a few weeks. If symptoms persist for more than three months, it is classified as chronic pericarditis. Recurrent pericarditis occurs when symptoms return after a symptom-free period, often posing a challenge for long-term management. Understanding what is pericarditis is crucial for recognizing its diverse presentations and potential impact on cardiovascular health.

Pericarditis Symptoms and Causes

Recognizing pericarditis symptoms and causes is vital for timely diagnosis and treatment. The most prominent symptom is chest pain, which is often sharp, stabbing, and may worsen with deep breathing, coughing, or lying flat. Conversely, the pain often improves when sitting up or leaning forward. Other common symptoms can include:

• Fever
• Fatigue and weakness
• Shortness of breath (dyspnea)
• Dry cough
• Palpitations
• Swelling in the legs or abdomen (in severe cases)

The causes of pericarditis are varied, though viral infections are the most common etiology, accounting for a significant percentage of acute cases. Other potential causes include bacterial, fungal, or parasitic infections. Autoimmune diseases such as lupus or rheumatoid arthritis can also trigger pericarditis. Furthermore, it can develop after a heart attack, heart surgery, chest trauma, kidney failure, or as a side effect of certain medications. In many instances, however, the exact cause remains unknown, referred to as idiopathic pericarditis.

Diagnosing and Treating Pericarditis

How is pericarditis diagnosed typically begins with a thorough physical examination, where a doctor may listen for a characteristic “pericardial rub” sound using a stethoscope. Electrocardiogram (ECG) is a key diagnostic tool, often showing specific changes indicative of pericardial inflammation. A chest X-ray can reveal an enlarged heart silhouette if there’s significant fluid buildup. An echocardiogram, which uses sound waves to create images of the heart, is crucial for assessing fluid around the heart (pericardial effusion) and its impact on heart function. Blood tests are also performed to check for markers of inflammation, such as C-reactive protein (CRP), and to identify potential underlying causes.

Once diagnosed, pericarditis treatment options focus on reducing inflammation, managing pain, and addressing any underlying cause. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, are often the first line of treatment. Colchicine is frequently used in conjunction with NSAIDs to reduce inflammation and prevent recurrence. In more severe or recurrent cases, corticosteroids may be prescribed, though their use is often limited due to potential side effects. For significant pericardial effusion that compromises heart function (cardiac tamponade), a procedure called pericardiocentesis may be performed to drain the excess fluid. In rare chronic cases, surgical removal of the pericardium (pericardiectomy) might be necessary. Rest is also a critical component of recovery, allowing the heart to heal and preventing complications.