Pericarditis

Pericarditis is an inflammation and swelling of the pericardium, a thin, saclike tissue that surrounds the heart. Sharp chest pain is a common symptom of pericarditis, among other symptoms. Usually, the inflamed pericardium layers rub against each other, resulting in chest pain.

Pericarditis is frequently acute, meaning it appears out of nowhere and can linger for months. The illness normally goes away after three months but may sometimes last for years. Therefore, early detection and diagnosis can help minimize the chances of prolonged complications due to the disease. 

 

Signs and Symptoms of Pericarditis 

Pericarditis can cause a stabbing or sharp pain in the chest that appears suddenly, similar to a heart attack. The pain may be felt behind the breastbone in the middle or left side of the chest. You may as well experience radiating pain in the neck, shoulders, arms, and jaw. 

Based on the kind of pericarditis you have, the associated symptoms can vary. Pericarditis is classified into several types depending on the pattern and the duration of symptoms. They include;

Acute pericarditis: Appears suddenly and lasts for three weeks or less. Future episodes of the condition are possible. It can be hard to distinguish acute pericarditis from pain caused by a heart attack.

Recurrent pericarditis: Develops four to six weeks following an acute pericarditis episode, without any symptoms in the duration. 

Incessant pericarditis: Usually lasts four to six weeks but not longer than three months. On the other hand, the signs and symptoms do not subside. 

Chronic constrictive pericarditis: This is characterized by a gradual onset and duration of more than three months. 

It is advisable to get medical care right immediately if you are experiencing sharp stabbing chest pain. Approximately 80 to 90 percent of patients with pericarditis get chest pains as the common symptom. They can also have other signs and symptoms such as; 

  • Fatigue or weakness 
  • Low fever 
  • Breathing difficulties, particularly when you are lying down 
  • Dry coughing 
  • Palpitation 
  • Swelling around the legs, feet, and ankles 

In most cases, pericarditis symptoms tend to aggravate if you take deeper breaths, lie flat, cough, or swallow. You might feel better if you sit upright and lean forward. If bacteria cause pericarditis, you might experience chills, fever, and an elevated white cell count. You may get flu-like and stomach symptoms if the underlying cause is viral. 

 

Causes of Pericarditis 

Pericarditis is usually difficult to diagnose. Doctors are sometimes unable to pinpoint the source of pericarditis disease. Nonetheless, pericarditis can occur due to a variety of factors, including; 

  • Heart surgery or heart attack; pericarditis or delayed pericarditis (Dressler's syndrome, also known as postmyocardial infarction syndrome or postcardiac damage syndrome) can be caused by a heart attack or cardiac surgery. 
  • A problem of the viral infection, most commonly a gastrointestinal virus, causes pericarditis virus.
  • A bacterial infection, such as tuberculosis causes bacterial pericarditis.
  • A fungal infection causes fungus pericarditis.
  • Parasitic pericarditis, which can result from a parasitic infection.
  • Systemic inflammatory illnesses such as lupus and rheumatoid arthritis. 
  • Trauma, including heart or chest injury sustained in a car accident or any other incident
  • Health condition such as kidney failure, tuberculosis, AIDS, and cancer

 

Pericarditis Diagnosis 

The medical provider will start by inquiring about the medical history, the symptoms you have, the onset, and what might be aggravating them. They will also conduct a physical examination on you. 

If the pericardium gets irritated, fluid can build up between the two layers of tissue within the sac, causing an effusion. A stethoscope will help check or listen for signs of extra fluid. The doctor will also keep an ear out for pericarditis rub due to friction. This is the sound of the pericardium scraping against your heart's outer layer. 

Other additional tests and procedures that the doctor might perform to make a pericarditis diagnosis are; 

An electrocardiogram (ECG): This is a simple and painless examination that monitors the electric signals in the heart. A monitor is connected to sticky patches or electrodes and wires attached to it. They keep track of the electrical impulses that cause your heart to beat. The data is then stored in a computer and displayed as waves on a paper or monitor. 

Chest x-ray: An X-ray of the chest might reveal changes in the shape and size of the heart. If extra fluid has accumulated in the pericardium, the pictures may indicate an enlarged heart. 

Echocardiogram: Ultrasound or sound waves provide pictures of the moving heart. This test enables the doctor to check how well the heart pumps blood and whether or not there is fluid accumulation within the pericardium. 

Cardiac computed tomography (CT) scan: This type of scan produce images of the heart and chest using x-rays. The test can be done to check for thickening in the pericardium, which could indicate constrictive pericarditis. In addition, doctors can request the procedure to rule out other sources of abrupt chest pain, including a pulmonary embolus (blood clotting in the lung) or an aorta tear (aortic dissection). 

Cardiac magnetic resonance imaging (MRI): This technique produces cross-sectional pictures of the heart using radio waves and a magnetic field. This can detect inflammation, thickness, or other alterations within the pericardium. 

 

Pericarditis Treatment 

Pericarditis treatment is usually based on the underlying cause or trigger if it is known. The doctor can prescribe antibiotics to treat a bacterial infection. 

Pericarditis is usually mild, and it will go away on its own with basic treatment, including anti-inflammatory drugs and rest. At times, the doctor can decide to treat you in the hospital first if you have other health risks. 

The initial goal of treatment is to relieve inflammation and pain while also lowering the chance of recurrence. For individuals who don't have any other health problems, standard treatment includes; 

  • Medications

Medical providers often prescribe anti-inflammatories and anti-swelling medications to ease pericarditis. Some of the examples are; 

Pain killers: Pain from pericarditis is commonly managed with over-the-counter analgesics, including aspirin and ibuprofen (Advil, Motrin IB). Strength pain reliever medications are also an option. 

Colchicine (Colcrys, Mitigare): This is an anti-inflammatory medication that doctors use to address acute pericarditis, as well as recurrent symptoms. If you have liver or renal illness, you should avoid taking this medication. Colchicine might also cause interference with other medicines. Therefore, before administering the drug, the doctor will thoroughly examine your medical history. 

Corticosteroids: These are potent anti-inflammatory drugs. If the symptoms do not improve with other medicines or if they reappear, the doctor can recommend a corticosteroid, including prednisone. 

  • Surgery and other treatment procedures

In a situation where pericarditis leads to fluid accumulation within the heart, the doctor can recommend surgery or drainage, including; 

Pericardiocentesis: This is a procedure in which a physician extracts and drains the extra pericarditis fluid from the pericardial cavity. This is done using a sterile needle or a tiny tube called a catheter. Before undergoing the procedure, the doctor will give you a numbing agent (local anesthesia). The needle and tubing are then guided to the target site in the body using ultrasound and echocardiogram pictures. During your stay in the hospital, this drain will remain in place for a few days. 

Pericardiectomy: This procedure involves the removal of the whole pericardium. The doctor can recommend this option if the sac around the heart has permanently grown inflexible because of constrictive pericarditis. 

 

Complications of Pericarditis 

Early pericarditis diagnosis and treatment is essential since it minimizes the chances of permanent complications. Pericarditis can sometimes lead to the following complications; 

Pericardial effusion: Pericarditis is generally linked with the fluid surrounding the heart, which could result in more severe consequences.

Chronic constrictive pericarditis: Sometimes, patients with long-term or chronic pericarditis get permanent pericardial thickness and scarring. This hinders the heart from effectively filling and emptying. Serious swelling of the abdomen and legs, as well as shortness of breath, are the common symptoms of this rare complication. 

Cardiac tamponade: This is a potentially fatal condition that occurs if a lot of fluid accumulates within the pericardium. The excess fluid exerts pressure on the heart and prevents it from adequately filling. Blood pressure drops dramatically when less blood flows from the heart. In most cases, cardiac tamponade needs immediate medical attention. 

 

Pericarditis Prevention 

Preventing pericarditis is almost impossible. However, you can reduce the chances of the condition recurring. Furthermore, it is essential to stick to your treatment regimen. Get enough rest and avoid demanding physical activities until you recover fully. Consult your doctor to determine how long you need to limit your exercise. If you notice any signs that might indicate recurrence, visit the physician as soon as you can.

 

Conclusion 

Pericarditis refers to the inflammation of the pericardium, which can be acute or chronic. It takes time to recover from pericarditis. In addition, the symptoms might take weeks to resolve in certain cases completely. Hence, you should seek medical help as soon as possible as this reduces the risks of complications. 

Most pericarditis cases are usually mild and have few side effects. Chronic pericarditis, on the other hand, can cause issues like fluid accumulation and pericardial constriction. The treatment of such associated complications includes a surgical procedure.