Definition and Overview

Pericarditis is a common heart condition characterized by the inflammation of the pericardium.

The heart is a muscular organ composed mainly of cardiac muscle, a type of muscle not found anywhere else in the body. Its main function is to help the heart pump blood efficiently. Outside the surface of the heart, however, is the pericardium, a thin sac that is filled with fluid and is made up of two thin layers.

The pericardium doesn’t have anything to do with the normal activities of the heart. But it provides additional protection to the organ by acting as a shield against possible infections that can threaten the valves, blood vessels, and muscles. It also prevents the heart from expanding so much when large volumes of blood come in.

However, for some unknown reason, the pericardium can be irritated, in which case it can become inflamed. Fortunately, the heart can still work effectively without the pericardium provided that the diaphragm and the lungs are undamaged.

Nevertheless, pericarditis requires immediate treatment. Otherwise, it can lead to a wide variety of serious complications. These include cardiac tamponade, which occurs when there’s a significant buildup of fluid in the pericardium. When this happens, it can lead to a huge drop in blood pressure as the heart fails to fill blood properly. This is considered life-threatening.

There are different types of pericarditis based on how often they occur. Most of the reported cases are acute pericarditis, which means they happen suddenly. The patient feels chest pain that may range from dull to aching. Another kind is recurrent, which implies the problem can appear and disappear at any given time. A person who develops the symptoms for at least three months is considered to have chronic pericarditis.

Consistent pericarditis may eventually lead to scarring or thickening of the pericardium, a condition known as constrictive pericarditis, which can prevent the heart from working well. Swelling of the extremities or the legs is also a possible outcome.

Causes of Condition

In the majority of the cases, the exact cause of pericarditis is unknown or undefined. However, based on many studies and evidence, some situations or conditions may lead to it. These include the following:

  • Mesothelioma – Mesothelioma is a type of cancer that affects the mesothelium, a thin lining that can be found in the internal chest wall and pericardium. It is often associated with exposure to asbestos. Mesothelioma has a very poor prognosis but takes many years before the symptoms appear.

  • Viral disease – As a protective layer of the heart, the pericardium is often exposed to pathogens such as viruses and bacteria, which can cause infection once they penetrate the organ. This also means that it’s the first thing that can contract the infection, which may then result in inflammation. Some of the viruses that may have an effect on the pericardium are flu and gastrointestinal viruses.

  • Surgery - Surgery, whether invasive or minimally invasive, carries a certain level of risk including infections and bleeding. Infections, for one, may have a direct effect on the pericardium. Sometimes a heart surgery may injure the pericardium, which may lead to irritation and swelling.

  • Autoimmune diseases – The body has its own defense called the immune system, which is designed to ward off, kill, or prevent infections from pathogens. However, sometimes, it undergoes genetic mutation or becomes more active that it starts attacking the healthy tissues and damaging the organ. These diseases can also cause undue damage to the pericardium.

  • Injury – An injury to the chest can make the pericardium swell.

There are also risk factors associated with the disease. For instance, males are more likely to develop it than females. It can also occur between the ages of 20 and 50. Those who have gone through heart attack, radiation therapy, or catheterization of the heart are also more prone to pericarditis.

Key Symptoms

  • Chest pain, which may be described as stabbing, sudden, or dull
  • Cough
  • Pleural effusion (buildup of fluid)
  • Shortness of breath
  • Swelling of the extremities especially the abdomen and legs
  • Fatigue
  • Feeling of being unwell
  • Coughing
  • Low-grade fever

The most distinct and common sign of pericarditis is chest pain. An acute pericarditis can begin with a sudden pain in the left side or central part of the chest, which then radiates toward the left shoulder— a symptom that is similar to a heart attack. With pericarditis, this pain should lessen once the person sits upright. On the other hand, it worsens when the person tries to lie down or breathe properly.

Meanwhile, a person may already be suffering from cardiac tamponade when he or she experiences the following:

  • Distress
  • Restlessness
  • Very low blood pressure
  • Rapid heart rate
  • Fainting spell
  • Dizziness
  • Unconsciousness

Who to See & Types of Treatment Available

Although a general internist can diagnose the condition, a cardiologist remains the best person to approach if you experience the symptoms listed above. To confirm pericarditis, different types of tests may have to be performed. These include:

  • X-rays and other imaging tests such as CT scan – These are performed to obtain a comprehensive image of the heart, especially the outer surface and fluid-filled sac. Regular X-rays, on the other hand, are used to determine any changes to the size or shape of the heart.

  • Physical exam – The doctor typically uses a stethoscope to listen to a specific sound that is unique in pericarditis.

  • ECG – Also known as electrocardiogram, it’s a heart test that measures the electrical activity of the heart. It involves the use of electrode pads that are connected to different parts of the body, mostly around the chest area, arms, and legs. The pads are connected to the machine, which “transcribe” these electrical impulses in a series of oscillations.

  • Echocardiogram – This cardiac examination uses a transducer to bounce off sound waves, which then create images of the heart, especially its shape and fluid accumulation in the pericardium.

In a number of cases, pericarditis can happen suddenly and disappear quickly as well. However, if it becomes more persistent, it’s wise to see a cardiologist, especially since the underlying condition may be serious, such as embolism of the lungs or a heart attack.

In mild cases, medications such as NSAIDs (non-steroidal anti-inflammatory drugs) may be provided in high doses. If the cause is confirmed to be bacteria, an antibiotic may also be given.

The NSAIDs may be combined with a drug known as colchicine, which has been known to be effective in controlling pericardium inflammation.

In rare cases such as when the patient has already developed constrictive pericarditis, the best option is surgery, particularly pericardiectomy, a procedure that removes a part or the whole pericardium.

Reference:

  • LeWinter MM, Tischler MD. Pericardial diseases. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 75
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