Pericarditis, Causes, Signs, Symptoms and Treatment

Pericarditis is a medical condition characterized by the inflammation of the pericardium, which is the thin sac-like membrane that surrounds the heart. The pericardium has two layers – an outer fibrous layer and an inner serous layer that produces a small amount of fluid to lubricate the heart’s movements.

When the pericardium becomes inflamed, it can lead to various symptoms such as chest pain, which is typically sharp and worsens with deep breaths or when lying down. This pain is often described as a squeezing or pressure sensation in the chest and can sometimes radiate to the neck, left shoulder, or back.

The diagnosis of pericarditis usually involves a thorough examination, medical history review, and additional tests such as an electrocardiogram (ECG), echocardiogram, blood tests, or a chest X-ray.

Causes of Pericarditis:

1. Viral Infections: Pericarditis can be caused by viral infections such as the flu, coxsackievirus, or cytomegalovirus. These infections can lead to inflammation of the pericardium, which is the sac that surrounds the heart.
2. Bacterial Infections: Certain bacterial infections, like pneumonia, tuberculosis, or endocarditis, can also result in pericarditis. The bacteria can spread to the pericardium, triggering an inflammatory response.
3. Autoimmune Disorders: Conditions like rheumatoid arthritis, lupus, or scleroderma can cause the immune system to attack the pericardium, leading to inflammation and pericarditis.
4. Injury or Trauma: Trauma to the chest, such as a car accident or a blow to the chest, can cause direct damage to the pericardium, causing it to become inflamed.
5. Medications: Some medications, like certain antibiotics or antineoplastic drugs, have been known to cause pericarditis as a side effect. It is important to be aware of the potential risks and consult with a healthcare professional.
6. Cancer: In rare cases, tumors in the chest or nearby structures can spread to the pericardium, leading to pericarditis. This is known as malignant pericarditis.
7. Kidney Failure: Pericarditis can occur in individuals with kidney failure, particularly in those undergoing dialysis. The buildup of waste products and fluid retention can contribute to pericardial inflammation.
8. Radiation Therapy: Radiation treatment for cancer, particularly if targeted near the chest area, can sometimes cause pericarditis as a late side effect.

Signs and symptoms of Pericarditis:

1. Chest Pain: The most common symptom of Pericarditis is chest pain. The pain is usually sharp and stabbing in nature, and it can be felt in the center or left side of the chest. The pain may worsen when lying down or taking deep breaths.
2. Difficulty Breathing: Pericarditis can also cause difficulty breathing, especially when engaging in physical activity or lying flat. This symptom is often described as shortness of breath or a feeling of being unable to catch your breath.
3. Fatigue: Many individuals with Pericarditis may experience fatigue or a general feeling of tiredness. This can be caused by the body’s immune response to the inflammation and the strain it puts on the heart.
4. Fever: In some cases, Pericarditis can be accompanied by a low-grade fever. This is the body’s natural response to inflammation and infection.
5. Rapid Heartbeat (Tachycardia): Pericarditis may cause an increased heart rate or palpitations. This can be due to the inflammation irritating the heart’s lining and disrupting the normal electrical signals.
6. Swelling: In severe cases, Pericarditis can lead to fluid accumulation around the heart, a condition called Pericardial Effusion. This can cause swelling in the legs, ankles, or abdomen, as well as a sensation of bloating.
7. Cough: Some individuals with Pericarditis may experience a dry cough, which is often persistent and worsens when lying down.
8. Pain Radiating to the Neck, Shoulder, or Back: The chest pain associated with Pericarditis may radiate to other areas of the upper body, such as the neck, shoulder, or back. This pain is typically sharp and localized.
9. Muscle Aches and Joint Pain: Pericarditis can sometimes cause generalized muscle aches and joint pain. This symptom is more common in cases where Pericarditis is caused by an underlying autoimmune condition.

Treatment of Pericarditis

The main goal of treatment is to relieve symptoms, reduce inflammation, and prevent complications.

1. Medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment in uncomplicated cases. They help reduce pain and inflammation. Commonly used NSAIDs include aspirin, ibuprofen, and indomethacin.
• Colchicine is a medication that has been shown to be effective in treating and preventing recurrent pericarditis. It is often used in conjunction with NSAIDs.
• Corticosteroids may be prescribed if the symptoms are severe or if other treatments fail. They work by suppressing the immune response and reducing inflammation. However, long-term use of corticosteroids may have side effects, so they are typically used for a limited time.

2. Antibiotics:

• If the cause of pericarditis is a bacterial infection, antibiotics are essential. The choice of antibiotic depends on the specific bacteria identified through laboratory testing. Prompt treatment with appropriate antibiotics is crucial to prevent complications and spread of infection.

3. Pericardiocentesis:

• In some cases, pericarditis may lead to the accumulation of fluid in the pericardial sac, a condition known as pericardial effusion. If the effusion is large and causing significant symptoms or impairing heart function, a procedure called pericardiocentesis may be performed. It involves the insertion of a needle or catheter into the pericardial sac to drain the excess fluid, relieving pressure on the heart.

4. Surgery:

• In rare cases of chronic or recurrent pericarditis that do not respond to medication or other treatments, surgery may be necessary. Procedures like pericardiectomy or pericardial window creation may be considered to remove the inflamed pericardium or create an opening to prevent fluid accumulation.

It’s worth noting that the treatment plan will vary depending on the underlying cause and severity of pericarditis.