Pericarditis: Inflammation Around the Heart – Causes, Symptoms, Prevention, and Treatment

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Pericarditis is a medical condition involving inflammation of the pericardium, the thin, two-layered sac-like membrane surrounding the heart. This membrane helps anchor the heart within the chest and contains a small amount of fluid to reduce friction as the heart beats. When this protective sac becomes inflamed, it can cause sharp chest pain and other serious complications if not properly managed.

Understanding pericarditis is vital for early diagnosis and effective treatment. This article explores its causes, symptoms, preventive measures, and available treatment options.

Causes of Pericarditis

Pericarditis can occur due to a wide variety of underlying conditions. In many cases, it is idiopathic, meaning no clear cause is identified. However, the most common causes include:

1. Viral Infections

  • The most frequent cause, especially in developed countries.
  • Common viruses: Coxsackievirus, echovirus, adenovirus, influenza, and COVID-19.

     

2. Bacterial Infections

  • Less common but more severe.
  • Includes tuberculosis (TB), staphylococcus, and streptococcus infections.

     

3. Fungal Infections

  • Rare, usually seen in immunocompromised patients.

     

4. Autoimmune Disorders

  • Conditions like lupus, rheumatoid arthritis, and scleroderma can trigger immune-mediated inflammation of the pericardium.

     

5. Heart Attack or Heart Surgery

  • Pericarditis can develop after a heart attack (Dressler’s syndrome) or cardiac surgery due to an inflammatory response.

     

6. Cancer

  • Metastatic cancers (lung, breast, lymphoma) can spread to the pericardium.

     

7. Kidney Failure (Uremic Pericarditis)

  • Chronic kidney disease can lead to accumulation of toxins causing pericardial irritation.

     

8. Radiation Therapy

  • Especially in patients treated for cancers in the chest area.

     

9. Injury or Trauma

  • Direct chest trauma, including accidents or invasive procedures like pacemaker insertion.

Symptoms of Pericarditis

The hallmark symptom of pericarditis is sharp, stabbing chest pain, but the presentation can vary based on the type and severity.

Common Symptoms:

  • Chest pain: Sharp or piercing, often felt behind the breastbone or on the left side. It may worsen with deep breathing, lying down, or coughing and improve when sitting up or leaning forward.
  • Fever: Mild to moderate, especially in viral or bacterial pericarditis.
  • Fatigue and weakness
  • Shortness of breath, especially when reclining.
  • Heart palpitations
  • Swelling in the abdomen or legs (if fluid buildup occurs).

Signs of Complications:

  • Pericardial effusion: Excess fluid buildup around the heart.
  • Cardiac tamponade: A life-threatening condition where fluid compresses the heart, reducing its ability to pump blood effectively.

Types of Pericarditis

There are several types based on duration and clinical features:

  1. Acute Pericarditis: Lasts less than 6 weeks. Sudden onset of pain.
  2. Subacute Pericarditis: Develops more gradually, often lasting weeks to months.
  3. Chronic Pericarditis: Lasts longer than 3 months, often due to unresolved inflammation.
  4. Recurrent Pericarditis: Symptoms return after a symptom-free interval.

Prevention of Pericarditis

While not all cases are preventable, especially idiopathic or autoimmune-related, several preventive measures can reduce the risk:

1. Prompt Treatment of Infections

  • Treat viral and bacterial infections early to avoid spread to the heart.

2. Regular Management of Chronic Conditions

  • Proper control of autoimmune diseases and kidney function can help prevent inflammation.

3. Heart Health Monitoring

  • Regular check-ups after a heart attack or surgery help detect early signs.

4. Avoid Chest Trauma

  • Use safety gear and follow medical guidelines during invasive procedures.

5. Immunizations

  • Vaccinations (e.g., flu, COVID-19) can reduce the risk of viral causes.

Diagnosis of Pericarditis

Medical Evaluation Includes:

  • Physical exam: A pericardial friction rub (scratchy sound) may be heard.
  • Electrocardiogram (ECG): Can show characteristic changes like ST-segment elevation.
  • Chest X-ray: Helps detect fluid around the heart or other causes.
  • Echocardiogram: Key to visualizing fluid and inflammation.
  • Cardiac MRI or CT scan: Provides detailed images of the pericardium.
  • Blood tests: Detect inflammation (CRP, ESR), infection, or underlying autoimmune disease.

Treatment of Pericarditis

Treatment depends on the underlying cause, type, and severity. Most acute viral pericarditis cases resolve with minimal intervention.

1. Medications

  • NSAIDs (e.g., ibuprofen, aspirin): First-line therapy for reducing inflammation and pain.
  • Colchicine: Reduces recurrence and inflammation.
  • Corticosteroids: Reserved for severe or refractory cases, or autoimmune-related pericarditis.
  • Antibiotics or antifungals: When infection is the confirmed cause.
  • Immunosuppressants: Used in autoimmune conditions.

2. Procedures

  • Pericardiocentesis: Draining excess fluid using a needle under imaging guidance.
  • Pericardiectomy: Surgical removal of the pericardium, usually in chronic or constrictive pericarditis unresponsive to other treatments.

3. Lifestyle Recommendations

  • Rest during acute episodes.
  • Avoid strenuous activity until inflammation resolves.
  • Gradual return to exercise under supervision.

Prognosis and Recovery

  • Most patients with acute pericarditis recover fully within a few weeks.
  • Recurrence is seen in 15–30% of cases.
  • Chronic or constrictive pericarditis can lead to long-term complications but is manageable with surgery.
  • Prompt diagnosis and treatment are key to a favorable outcome.

When to Seek Medical Attention

Seek immediate care if you experience:

  • Persistent chest pain
  • Difficulty breathing
  • Rapid heart rate
  • Fainting or dizziness

These could indicate cardiac tamponade, a medical emergency.

Conclusion

Pericarditis, though often a self-limiting condition, can become serious if ignored. With proper diagnosis, medical care, and preventive strategies, individuals can manage symptoms effectively and prevent recurrence or complications. Awareness and timely action are the best defenses against inflammation around the heart.

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