Pericarditis

Pericarditis is an inflammation of the pericardium (the fluid-filled sac surrounding the heart). A characteristic chest pain is often present. It is a common heart disease.

There are three main types of pericarditis:

• Acute pericarditis where the symptoms last less than three months (with treatment, symptoms normally resolve within a week)
• Recurring pericarditis – where someone has repeated episodes of acute pericarditis
• Chronic pericarditis – a complication of pericarditis, where the symptoms last longer than three months

References:

• www.nhs.uk
• www.nhlbi.nih.gov
• www.nlm.nih.gov

The most common symptom of acute pericarditis is sharp, stabbing chest pain which radiates to the bottom of scapula on the back, and is relieved by sitting up and bending forward and worsened by lying down (recumbent or supine position) or inspiration (taking a breath in).

Other symptoms include:

• A high temperature (fever) 
• Shortness of breath
• Fatigue
• Nausea
• Dry cough
• Swelling of the legs or abdomen

Reference:

• www.nhs.uk

The cause of pericarditis is not clear, but is often associated with the infection such as:

Viral infections that cause a chest cold or pneumonia, such as the echovirus or coxsackie virus (which are common in children), as well as influenza

Infections with bacteria (much less common)

Some fungal infections (even more rare)

Other factors include:

• Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever
• Trauma to the heart, e.g. puncture, resulting in infection or inflammation
• Malignancy
• Side effect of medications, e.g.warfarin, isoniazid, heparin and cyclosporine

Reference:

• www.nhs.uk

Pericarditis is generally ruled out through symptoms and physical examination and recent history.

A diagnosis is usually confirmed by electrocardiogram (ECG). During an ECG, electrodes are placed on skin to measure the electrical activity of heart.

Further tests include are:

• A chest X-ray
• Magnetic resonance imaging (MRI) scan
• A computer tomography (CT) scan
• An echocardiogram – this test is similar to an ultrasound scan, as it uses sound waves to build up a detailed picture of your heart and pericardium

Reference:

• www.nhs.uk

Most cases of pericarditis are successfully treated with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by reducing the inflammation of the pericardium. They also help in relieving the chest pain.

Severe cases may require:

• Pericardiocentesis: to treat pericardial effusion/tamponade
• Steroids are used in acute pericarditis but are not favored because they increase the chance of recurrent pericarditis.
• In cases of constrictive pericarditis, pericardiectomy may be done.

Reference:

• www.nhs.uk

There are two main types of chronic pericarditis:

• Chronic effusive pericarditis – when an excess of fluid gathers in the space inside the pericardium
• Chronic constrictive pericarditis – where the tissue of the pericardium becomes hardened through scarring

Cardiac tamponade: Inflammation of the pericardium can lead to a large build-up of fluid inside the pericardium. The extra fluid puts the heart under pressure, which makes it unable to pump blood around the body effectively. This is known as cardiac tamponade.

Reference: