Pericarditis

Pericarditis: Symptoms, Causes, Types, Diagnosis, and Treatments

Pericarditis is a condition characterized by inflammation of the pericardium — the thin, two-layered sac-like membrane surrounding the heart. This inflammation can cause sharp chest pain and other systemic symptoms that may mimic those of a heart attack, making timely diagnosis and management crucial. Though often mild and self-limiting, some cases of pericarditis can lead to serious complications like cardiac tamponade or chronic constrictive pericarditis.

In this comprehensive guide, we’ll explore the symptoms, causes, types, diagnosis, and treatments of pericarditis. Whether you are a medical student, a healthcare professional, or someone looking to better understand this condition, this article will provide a thorough insight into this often misunderstood cardiac disorder.

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What Is Pericarditis?

Pericarditis is the inflammation of the pericardium, which consists of two layers: the visceral and parietal pericardium. These layers are separated by a thin layer of fluid (pericardial fluid) that reduces friction as the heart beats. When inflammation occurs, excess fluid may accumulate, and the layers may rub against each other, causing pain and discomfort.

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Symptoms of Pericarditis

The hallmark symptom of pericarditis is chest pain, but the clinical presentation may vary depending on the type and severity.

Common Symptoms Include:

1. Chest Pain:
   • Sharp or stabbing pain, often behind the breastbone or on the left side.
   • Pain may worsen with deep breaths, coughing, or lying down.
   • Relief often occurs when sitting up or leaning forward.
2. Shortness of Breath:
   • Especially noticeable when reclining.
3. Palpitations:
   • Sensation of a racing or irregular heartbeat.
4. Low-grade Fever:
   • Especially if the cause is viral or bacterial.
5. Fatigue and General Malaise:
   • Due to the body’s inflammatory response.
6. Swelling in the Legs or Abdomen:
   • More common in constrictive pericarditis.
7. Pericardial Friction Rub:
   • A scratchy or grating sound heard through a stethoscope.

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Causes of Pericarditis

Pericarditis can result from various causes, with many cases labeled as idiopathic, meaning no specific cause is identified.

1. Infectious Causes:

• Viral Infections: Most common (e.g., Coxsackievirus, echovirus, HIV, influenza).
• Bacterial Infections: Including tuberculosis (TB) and pneumonia-related infections.
• Fungal Infections: Rare, but possible in immunocompromised patients.
• Parasitic Infections: Uncommon, typically in endemic regions.

2. Non-Infectious Causes:

• Autoimmune Disorders:
  • Lupus, rheumatoid arthritis, scleroderma.
• Post-Myocardial Infarction (Dressler’s Syndrome):
  • Autoimmune response after heart tissue damage.
• Uremia:
  • Associated with end-stage renal disease.
• Cancer:
  • Direct invasion or metastasis from breast or lung cancer, lymphoma, etc.
• Radiation Therapy:
  • Especially in patients with chest radiation.
• Trauma or Surgery:
  • Cardiac surgeries or blunt chest injuries.
• Medications:
  • Certain drugs like hydralazine, isoniazid, and phenytoin.

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Types of Pericarditis

Pericarditis can be classified based on the duration, clinical features, or underlying pathology.

1. Acute Pericarditis:

• Sudden onset.
• Symptoms last less than 6 weeks.
• Common in young adults.
• Usually self-limiting.

2. Subacute Pericarditis:

• Symptoms develop gradually and last between 6 weeks to 6 months.

3. Chronic Pericarditis:

• Persists longer than 6 months.
• Can cause long-term complications such as pericardial thickening.

4. Recurrent Pericarditis:

• Reappearance of symptoms after symptom-free intervals.
• May follow a previous acute episode.

5. Constrictive Pericarditis:

• Thickened, scarred pericardium restricts heart movement.
• May mimic heart failure.

6. Pericardial Effusion:

• Excess fluid buildup in the pericardial sac.
• If fluid accumulates rapidly, it may lead to cardiac tamponade, a life-threatening condition.

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Diagnosis of Pericarditis

A careful medical history and physical examination are essential in diagnosing pericarditis. However, diagnostic tools are crucial in confirming the diagnosis and ruling out other conditions.

1. Physical Examination:

• Pericardial friction rub is a classic finding.
• May hear muffled heart sounds in case of effusion.

2. Electrocardiogram (ECG):

• Shows widespread ST-segment elevation and PR depression.
• Helps differentiate from myocardial infarction.

3. Chest X-Ray:

• May reveal an enlarged heart silhouette if there’s a significant effusion.

4. Echocardiogram:

• Visualizes the pericardium and detects pericardial effusion.
• Essential in assessing cardiac tamponade.

5. Cardiac MRI or CT Scan:

• Used in complex cases.
• Identifies thickening, inflammation, or constriction.

6. Blood Tests:

• Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) indicate inflammation.
• Troponin levels may be mildly elevated.
• Testing for autoimmune markers or infectious agents if indicated.

7. Pericardial Fluid Analysis:

• Performed during pericardiocentesis to identify infectious or malignant causes.

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Treatment of Pericarditis

Treatment depends on the severity, cause, and whether complications are present.

1. Medications:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

• First-line treatment.
• Examples: Ibuprofen, aspirin.
• Relieve pain and reduce inflammation.

Colchicine:

• Often combined with NSAIDs.
• Reduces recurrence risk.
• Course usually 3–6 months.

Corticosteroids:

• For patients who do not respond to NSAIDs and colchicine.
• Used cautiously, as they increase recurrence risk.

Antibiotics or Antifungals:

• For bacterial or fungal pericarditis.

Immunosuppressive Therapy:

• For autoimmune-related pericarditis (e.g., lupus).
• Drugs include azathioprine or methotrexate.

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2. Surgical and Interventional Treatments:

Pericardiocentesis:

• Drainage of excess pericardial fluid.
• Done in emergencies like cardiac tamponade.

Pericardiectomy:

• Surgical removal of the pericardium.
• Indicated in constrictive pericarditis or recurrent chronic cases.

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3. Lifestyle Modifications:

• Rest during the acute phase.
• Avoid strenuous activity until recovery.
• Follow up regularly with a cardiologist.
• Monitor for recurrence.

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Complications of Pericarditis

While many cases resolve with minimal intervention, complications may arise:

1. Cardiac Tamponade:

• Rapid fluid accumulation compresses the heart.
• Medical emergency.
• Symptoms: Low blood pressure, muffled heart sounds, jugular venous distension.

2. Constrictive Pericarditis:

• Scarring and loss of pericardial elasticity.
• Restricts heart movement.
• May cause signs of right-sided heart failure.

3. Recurrent Pericarditis:

• Repeated episodes even after treatment.
• Often idiopathic or autoimmune in origin.

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Prognosis and Recovery

The outlook for pericarditis depends on its cause and whether complications develop.

• Acute viral pericarditis has an excellent prognosis and often resolves in days to weeks.
• Recurrent and constrictive pericarditis may require long-term management or surgery.
• Early treatment and proper diagnosis greatly improve outcomes.

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Pericarditis in Special Populations

1. Children:

• Often viral.
• Symptoms may be vague (irritability, abdominal pain).
• Requires careful evaluation.

2. Elderly:

• Higher risk of complications.
• More likely to have comorbid conditions.

3. Immunocompromised Individuals:

• More susceptible to infectious causes.
• Require aggressive diagnosis and treatment.

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Preventing Pericarditis

While not all cases are preventable, some measures can reduce risk:

• Timely treatment of respiratory and systemic infections.
• Manage autoimmune conditions effectively.
• Avoid chest trauma and risky medications.
• Regular follow-up after cardiac surgery.

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Conclusion

Pericarditis is a condition that, while often benign, can have serious implications if not properly managed. Understanding the symptoms, identifying the causes, and initiating prompt treatment are essential for a positive outcome. With advances in diagnostic tools and treatments, most patients recover fully, especially when the condition is identified early.

Whether caused by a viral infection, autoimmune response, or other factors, pericarditis serves as a reminder of how closely the heart is connected to the rest of the body’s systems. If you or someone you know experiences persistent chest pain, seek medical advice — early diagnosis saves lives.

Frequently Asked Questions (FAQs) About Pericarditis

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