Pericarditis: Symptoms, Causes, Treatment

What are the symptoms of pericarditis?

Pericarditis is the inflammation of the pericardium, the protective sac surrounding the heart. Symptoms can vary but commonly include:

1. Chest Pain

• Sharp or Stabbing Pain: Often described as sharp or stabbing and located in the chest. The pain might worsen with deep breathing, coughing, or lying down.
• Relief with Sitting Up: Pain may improve when sitting up and leaning forward.

2. Fever

• Low-Grade Fever: A mild fever is often present and can be a sign of inflammation or infection.

3. Shortness of Breath

• Difficulty Breathing: Particularly when lying down or exerting oneself.

4. Fatigue

• General Tiredness: Feelings of weakness and general fatigue are common.

5. Cough

• Dry Cough: A non-productive cough can occur, though it is less common than other symptoms.

6. Palpitations

• Heart Palpitations: Some people may feel a sensation of rapid heartbeat or irregular heartbeat.

7. Swelling

• Edema: In some cases, swelling of the legs or abdomen may occur, particularly if pericarditis leads to fluid accumulation in the pericardial space (pericardial effusion).

8. Symptoms of Underlying Conditions

• Signs of Infection: If pericarditis is due to an infection, symptoms might include signs of an underlying illness such as sore throat, joint pain, or rash.

Summary

The most characteristic symptom of pericarditis is sharp chest pain that can be alleviated by sitting up and leaning forward. Other symptoms include fever, shortness of breath, fatigue, cough, palpitations, and possible swelling. If you experience these symptoms or suspect pericarditis, it is important to consult a healthcare provider for proper evaluation and management.

What are the causes of pericarditis?

Pericarditis, the inflammation of the pericardium, can be caused by a variety of conditions. The primary causes of pericarditis include:

1. Infectious Causes

• Viral Infections: The most common cause, often related to viruses such as Coxsackievirus, echovirus, or other enteroviruses.
• Bacterial Infections: Including tuberculosis, pneumonia, and other bacterial infections.
• Fungal Infections: Rare but can occur in immunocompromised individuals.
• Parasitic Infections: Such as those caused by certain parasites in endemic areas.

2. Autoimmune Diseases

• Systemic Lupus Erythematosus (SLE): An autoimmune disease that can lead to inflammation of the pericardium.
• Rheumatoid Arthritis: Can cause pericarditis as part of a broader systemic involvement.
• Scleroderma: Another autoimmune condition that can affect the pericardium.

3. Post-Myocardial Infarction

• Acute Post-Myocardial Infarction Pericarditis: Also known as Dressler’s syndrome, which occurs after a heart attack.
• Early Post-Myocardial Infarction Pericarditis: Occurs within the first 2-4 days after a heart attack.

4. Trauma

• Physical Injury: Such as from a chest injury or surgery.
• Medical Procedures: Including cardiac surgery or catheterization.

5. Malignancy

• Cancer: Tumors, either primary or metastatic, can invade the pericardium and cause inflammation.

6. Renal Failure

• Chronic Kidney Disease: Advanced kidney failure can lead to uremic pericarditis.

7. Idiopathic

• Unknown Cause: In many cases, the exact cause of pericarditis cannot be identified and is classified as idiopathic.

8. Drug Reactions

• Medication-Induced Pericarditis: Some medications can cause pericarditis as an adverse reaction.

Summary

Pericarditis can result from infections, autoimmune diseases, post-heart attack inflammation, trauma, malignancy, renal failure, drug reactions, or sometimes has no identifiable cause. Identifying the underlying cause is crucial for effective treatment and management of the condition.

How is the diagnosis of pericarditis made?

Diagnosing pericarditis involves a combination of clinical evaluation, medical history, physical examination, and various diagnostic tests. Here’s a step-by-step approach to the diagnosis:

1. Medical History

• Symptoms Review: Discussion of symptoms such as chest pain, fever, shortness of breath, and any recent illnesses or injuries.
• Past Medical History: Reviewing any previous heart problems, infections, or autoimmune diseases.

2. Physical Examination

• Chest Examination: The physician listens for characteristic signs using a stethoscope. A friction rub, which is a scratchy or grating sound, is often heard in pericarditis.
• General Examination: Checking for other signs that might indicate an underlying condition, such as rash, joint pain, or signs of systemic infection.

3. Diagnostic Tests

• Electrocardiogram (ECG): An ECG can show changes typical of pericarditis, such as ST-segment elevation or PR-segment depression.
• Echocardiogram: This imaging test uses sound waves to create images of the heart. It helps to assess for fluid accumulation in the pericardial space (pericardial effusion) and evaluate the heart’s function.
• Chest X-ray: Used to visualize the heart and lungs. It may show an enlarged heart or other signs related to pericardial effusion.
• Blood Tests:
• Inflammatory Markers: Such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can indicate inflammation.
• Complete Blood Count (CBC): To check for signs of infection or anemia.
• Blood Cultures: If an infection is suspected.
• Pericardiocentesis: In some cases, a sample of pericardial fluid is obtained using a needle to analyze for infection, cancer, or other causes.

4. Additional Tests

• Cardiac MRI: May be used to provide detailed images of the pericardium and detect inflammation.
• CT Scan: Can help in assessing pericardial effusion or identifying any structural abnormalities.

Summary

Diagnosing pericarditis involves a thorough review of symptoms and medical history, a physical examination to detect characteristic signs, and a series of tests including ECG, echocardiogram, chest X-ray, and blood tests. In some cases, additional imaging or procedures like pericardiocentesis may be required to determine the underlying cause and guide treatment.

What is the treatment for pericarditis?

The treatment for pericarditis aims to address the underlying cause, relieve symptoms, and prevent complications. Treatment approaches vary based on the cause and severity of the condition. Here’s a general outline of treatment strategies:

1. Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen or indomethacin are commonly used to reduce inflammation and relieve pain.
• Colchicine: Often used in addition to NSAIDs to reduce symptoms and prevent recurrences, especially in cases of idiopathic or viral pericarditis.
• Corticosteroids: Such as prednisone may be prescribed if NSAIDs and colchicine are not effective, or if the pericarditis is due to autoimmune conditions or other specific causes.
• Antibiotics or Antifungal Medications: If pericarditis is caused by a bacterial or fungal infection, appropriate antibiotics or antifungals are prescribed.

2. Treatment of Underlying Conditions

• Autoimmune Diseases: Management of conditions like lupus or rheumatoid arthritis with appropriate immunosuppressive therapies.
• Renal Failure: Treatment of underlying kidney disease if pericarditis is due to uremia.
• Malignancy: Treatment of cancer if it is causing pericarditis.

3. Pain Management

• Analgesics: For pain relief, acetaminophen or other pain relievers may be used if NSAIDs are not suitable or effective.

4. Management of Pericardial Effusion

• Observation: If the effusion is small and not causing symptoms, regular monitoring might be sufficient.
• Pericardiocentesis: A procedure to drain excess fluid from the pericardial space if the effusion is large or causing symptoms.
• Surgery: In chronic or recurrent cases, a procedure called pericardial window or pericardiectomy may be performed to prevent fluid buildup.

5. Lifestyle and Home Care

• Rest: Adequate rest and avoidance of strenuous activities can help in the recovery process.
• Follow-Up Care: Regular follow-up with a healthcare provider to monitor the condition and adjust treatment as needed.

6. Monitoring and Follow-Up

• Regular Check-Ups: To monitor the effectiveness of treatment and check for potential complications or recurrences.

Summary

Treatment for pericarditis involves a combination of medications to reduce inflammation and pain, addressing any underlying conditions, managing symptoms, and sometimes procedures to deal with complications like pericardial effusion. The specific treatment plan will depend on the cause and severity of the pericarditis and should be tailored to each individual’s needs.