Pericarditis: Causes, Symptoms, Diagnosis, Treatment, Prevention and Complications

Pericarditis is an inflammation and swelling of the pericardium, the delicate, sac-like tissue that surrounds the heart. Acute chest pain is a characteristic pericarditis symptom. Chest pain happens when the layers of the irritated pericardium brush against one another.

Most frequently, mild cases of pericarditis heal on their own. Medication and, in rare instances, surgery may be used as treatments for more severe cases. Early detection and intervention could lessen the chance of pericarditis-related long-term consequences.

Causes Of Pericarditis

Pericarditis frequently has an unknown origin. It's possible that idiopathic pericarditis has no known cause.

Causes of pericarditis can include:

• Immune system reaction following cardiac injury brought on by a heart attack or heart surgery (also known as Dressler syndrome, postmyocardial infarction syndrome, or post-cardiac injury syndrome)
• An infection like COVID-19
• Disorders characterized by inflammation, such as lupus and rheumatoid arthritis
• Heart or chest injuries
• Various chronic conditions, like cancer and kidney disease

Symptoms Of Pericarditis

The most typical pericarditis symptom is chest discomfort. Usually, it feels piercing or sharp. 

Other people, however, have mild, achy, or pressure-like chest pain.

Typical locations for pericarditis pain include the left side of the chest and the area behind the breastbone. Pain could:

• The left shoulder and neck are spread out.
• Become worse when sneezing, lying down, or breathing deeply
• When standing or bending forward, improve

Other pericarditis warning signs and symptoms may include:

• Cough
• Sickness, generalised weakness, or exhaustion
• Ankle swell
• Mild fever
• Heart palpitations, a pounding or frantic heartbeat
• Breathing difficulty while lying down
• Abdominal (belly) swelling

The particular symptoms vary depending on the pericarditis type. Depending on the pattern of symptoms and how long they remain, pericarditis is divided into various types.

• Acute pericarditis develops rapidly and lasts no more than three weeks. Future incidents are possible. It could be challenging to distinguish between pain from a heart attack and acute pericarditis.
• After an episode of acute pericarditis, recurrent pericarditis develops roughly four to six weeks later with no symptoms in between.
• Pericarditis that is persistent lasts for four to six weeks, but not longer than three months. The signs never go away.
• Typically, chronic constrictive pericarditis takes longer than three months to develop and progress.

Diagnosis Of Pericarditis

In order to identify pericarditis, a medical professional would often do an examination and inquire about your symptoms and medical background.

It is customary to place a stethoscope on the back and chest to hear heartbeats. A pericardial rub is a particular sound that pericarditis produces. When the two layers of the pericardium, the sac that surrounds the heart, rub against one another, noise is produced.

Typically, blood tests are performed to look for indicators of an infection, inflammation, or heart attack. Various other exams may be used to identify pericarditis, such as:

• ECG: Electrocardiogram. A simple and painless test called an ECG captures the electrical activity of the heart. Wires from sticky electrode patches (patch electrodes) connect to a monitor. It is possible to record the electrical impulses that the heart uses to beat. The data is stored in a computer, which then displays it as waves on a screen or on paper.
• A Chest X-ray. Changes in the heart's size and shape can be seen on a chest X-ray. It can help in determining whether the heart is enlarged.
• Echocardiogram. Ultrasound produces images of the beating heart. An echocardiography can reveal whether fluid has accumulated in the tissue surrounding the heart and how efficiently the heart is pumping blood.
• Computerized tomography (CT) scan of the heart. X-rays are used in cardiac CT scans to provide images of the heart and chest. A constrictive pericarditis symptom that might be detected using this test is a thickening of the heart.
• Magnetic resonance imaging (MRI) of the heart. Cardiovascular MRI uses a magnetic field and radio waves to create cross-sectional images of the heart.The thin tissue surrounding the heart may have thickened, been inflamed, or undergone other changes, according to a cardiac MRI scan.

Treatment Of Pericarditis

The best course of treatment for pericarditis will depend on the cause and severity of the symptoms. Even without treatment, mild pericarditis may get better.

Medications

Medications are frequently administered to lessen the swelling and inflammation. Examples comprise:

• Drugs that reduce pain. Pain from pericarditis is typically manageable with over-the-counter analgesics such as aspirin or ibuprofen (Advil, Motrin IB, etc.). Additionally, prescription painkillers may be used.
• Colcrys, Mitigare, and colchicine. This medication lessens bodily inflammation.  It is used to treat recurring symptoms or acute pericarditis. Other medications may also be affected by colchicine. Prior to administering colchicine, your doctor will thoroughly review your medical history.
• Corticosteroids. Corticosteroids are potent anti-inflammatory drugs. If other treatments don't work to relieve pericarditis symptoms or if symptoms keep coming back, a corticosteroid like prednisone may be recommended.
• Antibiotics and drainage may be utilized in the event that a bacterial infection is the source of the pericarditis.

Surgery

Surgery or another technique can be required to remove the fluid if pericarditis leads to a buildup of fluid around the heart.

To cure pericarditis, surgeries or other techniques include:

• Pericardiocentesis. This treatment involves draining the extra fluid from the pericardial cavity using a catheter or a sterile needle.
• Pericardiectomy: the removal of the pericardium. If the sac enclosing the heart is chronically inflexible, removal of the entire pericardium may be necessary.

Prevention Of Pericarditis

Pericarditis cannot be prevented specifically. However, following these recommendations to avoid infections may lessen the chance of developing heart inflammation:

• Prior to their recovery, stay away from those who are ill with a viral or flu-like disease. If you are experiencing the signs of a viral infection, try to avoid spreading it to others.
• Observe good hygiene. Regular hand washing can help stop the spread of disease.
• Purchase the immunizations that are advised. Keep up-to-date on all advised vaccinations, particularly those that guard against illnesses like COVID-19, rubella, and influenza, which can result in myocarditis. Rarely, the COVID-19 vaccination can result in heart muscle inflammation and pericarditis, especially in boys between the ages of 12 and 17. With your healthcare provider, go over the benefits and drawbacks of immunizations.

Complications Of Pericarditis

The risk of consequences is typically lower with early detection and treatment of pericarditis. Pericarditis may result in the following complications:

• Pericardial effusion is the accumulation of fluid surrounding the heart. Further heart problems may result from the fluid buildup.
• Constrictive Pericarditis- Heart lining thickening and scarring are symptoms of constrictive pericarditis. Some people with chronic pericarditis develop permanent scarring and thickening of the pericardium. The heart cannot adequately fill and empty due to the alterations. Shortness of breath, severe limb and abdominal edema, and other unexpected complications are frequently caused by this condition.
• (Cardiac tamponade) Pressure on the heart is brought on by an accumulation of fluid. The heart cannot properly fill due to this potentially fatal disease. A significant decrease in blood pressure results from less blood leaving the heart. Treatment for cardiac tamponade is urgently necessary.

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