Photo from draxe.com
Pericarditis is an inflammation and irritation of the thin, sac-like tissue that surrounds the heart (pericardium). Sharp chest pain is a common symptom of pericarditis. The pericardium's inflamed layers rub against each other, causing chest pain.
Pericarditis is usually mild and resolves on its own. Medication and, in rare situations, surgery may be used to treat more severe cases. Early detection and treatment of pericarditis may help lower the risk of long-term consequences.
WHAT ARE THE SYMPTOMS OF PERICARDITIS?
The most common pericarditis symptom is chest discomfort. It is frequently sharp or stabbing. Some patients, however, experience dull, achy, or pressure-like chest pain.
Pain from pericarditis is typically felt behind the breastbone or on the left side of the chest. The discomfort may include:
- Spreads to left shoulder and neck
- When coughing, lying down, or taking a deep breath, the symptoms worsen.
- Get better when sitting up or tilting forward
Pericarditis may also cause the following signs and symptoms:
- Cough
- Fatigue or an overall sense of weakness or illness
- Swelling of the legs
- Low-grade fever
- Heartbeat pounding or racing (heart palpitations)
- When lying down, you may have shortness of breath.
- Stomach swelling (abdomen)
The symptoms vary depending on the type of pericarditis. Pericarditis is classified into several types based on the pattern of symptoms and the duration of symptoms.
- Acute pericarditis appears rapidly and lasts no more than three weeks. Future episodes are possible. It may be difficult to distinguish between acute pericarditis and pain caused by a heart attack.
- Recurrent pericarditis develops four to six weeks following an acute pericarditis episode, with no symptoms in between.
- Pericarditis that is persistent lasts four to six weeks, but no longer than three months. The symptoms remain ongoing.
- Chronic constrictive pericarditis typically develops gradually and lasts for more than three months.
WHAT ARE THE CAUSES OF PERICARDITIS?
Pericarditis is frequently difficult to diagnose. A cause may not be discovered (idiopathic pericarditis).
Causes of pericarditis include:
- Immune system reaction following heart damage caused by a heart attack or heart surgery (Dressler syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
- Infections like COVID-19
- Inflammatory disorders, such as lupus and rheumatoid arthritis
- A heart or chest injury
- Other chronic illnesses, such as kidney failure and cancer
WHAT ARE THE COMPLICATIONS OF PERICARDITIS?
The risk of consequences is usually reduced if pericarditis is diagnosed and treated early. Pericarditis can lead to the following complications:
- Fluid buildup surrounding the heart (pericardial effusion): Fluid buildup can lead to additional heart issues.
- Heart lining thickening and scarring (constrictive pericarditis): Long-term pericarditis can cause chronic thickening and scarring of the pericardium in certain persons. The alterations inhibit the heart from appropriately filling and emptying. This rare consequence frequently results in considerable swelling of the legs and abdomen, as well as shortness of breath.
- Pressure on the heart caused by fluid buildup (cardiac tamponade): This potentially fatal disease stops the heart from adequately filling. Less blood leaves the heart, resulting in a significant reduction in blood pressure. Cardiac tamponade necessitates immediate medical attention.
HOW IS PERICARDITIS DIAGNOSED?
A health care practitioner would usually examine you and ask questions about your symptoms and medical history to diagnose pericarditis.
To listen to heart sounds, a stethoscope is commonly placed on the chest and back. Pericarditis produces a distinct sound known as a pericardial rub. The noise is caused by the rubbing of the two layers of the sac enclosing the heart (pericardium).
Typically, blood tests are performed to look for indicators of a heart attack, inflammation, or infection. Other tests that may be used to identify pericarditis include:
- Echocardiogram: Ultrasound waves provide images of the beating heart. An echocardiography can detect fluid buildup in the tissue surrounding the heart and how well the heart pumps blood.
- Cardiac computerized tomography (CT) scan: Cardiac CT scans capture images of the heart and chest using X-rays. The test can detect cardiac thickening, which may indicate constrictive pericarditis.
- Cardiac magnetic resonance imaging (MRI): Cardiac MRI creates cross-sectional images of the heart by using a magnetic field and radio waves. A cardiac magnetic resonance imaging (MRI) scan can detect thickness, inflammation, or other changes in the thin tissue that surrounds the heart.
- Electrocardiogram (ECG): An ECG is a non-invasive test that monitors electrical signals in the heart. A monitor is connected by sticky patches (electrodes) with wires attached. They record the electrical signals produced by the heart. A computer stores the data and presents it as waves on a screen or on paper.
- Chest X-ray: An X-ray of the chest can reveal changes in the size and shape of the heart. It can aid in the detection of an enlarged heart.
WHAT ARE THE TREATMENTS FOR PERICARDITIS?
Pericarditis treatment is determined by the origin and severity of the symptoms. Mild pericarditis may resolve on its own.
Medications
Medication to relieve inflammation and swelling is frequently recommended. Here are several examples:
- Pain relievers: Pain from pericarditis is typically treated with over-the-counter pain medications such as aspirin or ibuprofen (Advil, Motrin IB, others). Prescription pain medications may also be used.
- Colchicine (Mitigare, Colcrys): This medication helps to reduce inflammation in the body. It is used to treat acute pericarditis or if symptoms reoccur. If you have liver or renal illness, you should not use this medication. Colchicine might also interact with other medications. Before administering colchicine, your doctor will thoroughly review your medical history.
- Corticosteroids: Corticosteroids are potent anti-inflammatory drugs. If alternative drugs do not relieve pericarditis symptoms or if symptoms reappear, a corticosteroid such as prednisone may be recommended.
If the pericarditis is caused by a bacterial infection, medications and drainage may be required.
Other procedures or surgeries
If pericarditis causes fluid buildup around the heart, surgery or another technique to drain the fluid may be required.
Pericarditis can be treated with surgery or other techniques such as:
- Pericardiocentesis: A sterile needle or a tiny tube (catheter) is used in this technique to remove and drain excess fluid from the pericardial cavity.
- Pericardiectomy (removal of the pericardium): If the sac enclosing the heart becomes chronically inflexible owing to constrictive pericarditis, the entire pericardium may need to be removed.