Pericarditis

What is pericarditis?

The pericardium is a fluid filled, double-walled sac that contains the heart. While the sac positions the heart in the thoracic cavity, the fluid acts as shock absorber. Swelling or inflammation of the pericardial sac is called pericarditis. Typical symptom of pericarditis includes sharp chest pain that appears spontaneously and usually persists for a shorter duration. Other non-specific signs may not immediately raise the suspicion of a cardiac-related problem especially in children and young adults.

What are the symptoms of pericarditis?

Sharp, stabbing pain in the left side of the chest is the main symptom of pericarditis. The pain may also spread to the neck, shoulders and back. While sitting or bending forward provides relief, coughing, swallowing or taking a deep breath may intensify the pain. Often the pain associated with pericarditis is confused with the chest pain of a heart attack.

The intensity of the pain is related to the severity of the condition. Apart from pain, the chronic form of disease presents accumulation of fluid in the pericardial sac. In severe cases this can hamper normal filling of the heart within the blood. Swelling in legs and feet may also be seen.

Other common symptoms include:

  • Shortness of breath
  • Fever
  • Weakness and fatigue
  • Dry cough

What causes pericarditis?

The exact causes of pericarditis are unknown. The pericardial sac covering the heart is a two-layered structure, filled with fluid. In most of the cases, the tissue of the pericardial sac gets inflamed. The pain usually appears when the inflamed layer of sac rubs against the other.

Infections, caused by viruses or bacteria, are considered to be the major cause. Fungal and parasitic infections can also cause pericarditis but this is rare. Some childhood viral infections like mumps and measles may complicate into pericarditis.

Pericarditis can also develops as an immediate consequence of a heart attack. It can also develop after surgery for a heart attack or other cardiac conditions and this is known as Dressler syndrome.

Some other risk factors that increase that chance of developing pericarditis include:

  • General inflammatory diseases like rheumatoid arthritis, systemic lupus erythematosus and sarcoidosis
  • Chronic illness like kidney failure, cancer, heart attack and hypothyroidism
  • Side-effects of chemotherapy, heart medications and smallpox vaccine
  • Autoimmune diseases such as lupus and scleroderma

Most cases of pericarditis occur in males 20 to 50 of age, although it can also occur in women. It can sometimes be chronic thereby requiring surgery to prevent repeated attacks.

How is pericarditis treated?

The focus of treatment is to stabilize the patient, reduce inflammation and control pain. The underlying cause should be treated as well. Viral pericarditis often resolves on its own and only requires supportive measures. Sometimes antiviral drugs may need to be used.  Bacterial or fungal infections require antibiotics and antifungal drugs respectively. Corticosteroids controls inflammation and is useful in chronic inflammatory diseases.

In case of chronic pericarditis, the exess fluid surrounding the heart is aspirated off from the pericardial sac, using a needle (pericardiocentesis). The accumulated fluid could also be drained out by making a small hole in pericardial sac. In case of recurrent pericarditis, complete surgical removal of pericardial tissue, called pericardiectomy, is performed.

 

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