Heart Health: What is Pericarditis?

What is Pericarditis?

Pericarditis is an inflammation of the lining that surrounds the heart. It is a relatively common cardiac disorder that affects 5% of all heart disease sufferers, being more common in men. The condition affects people of all ages, but mostly occurs in young adults.

The heart is lined with cells inside and outside. The cells that line the heart and valves inside are known as endocardium. Those that line it outside are known as the pericardium. The pericardium is a thin double-walled membrane or sac that encloses the heart and the roots of the great vessels.

The sac has two layers – a fibrous layer and a serous layer. Between these two layers there is a small amount of pericardial fluid, which keeps the layers from causing friction. The pericardium holds the heart in its place, provides lubrication necessary for it working properly and protects against infection.

In pericarditis the pericardial layers become swollen and irritated and start rubbing against each other causing chest pain similar to pain from a heart attack. It can be sudden, sharp and stabbing behind the breastbone, or it can be dull. More often it gets worse when lying down or inhaling and improves when sitting up and leaning forward.Other symptoms may include:

• Piercing pain that radiates up from the chest into the left shoulder and neck;
• Rapid heart palpitation;
• Shortness of breath when reclining;
• Low grade fever;
• Cough;
• Swelling of legs or abdomen;
• Overall sense of fatigue, weakness or feeling sick.

In most cases the cause of pericarditis remains unknown. Usually doctors suspect a viral infection, although the virus may never be detected. Fungal, bacterial and other types of infection can also cause the disease.

Pericarditis may also develop after a heart attack or cardiac surgery. It can also be caused by:

• systemic inflammatory disorders, like lupus or rheumatoid arthritis;
• trauma to the heart or chest in an injury accident;
• other medical conditions, like kidney failure, tuberculosis, AIDS or cancer;
• radiotherapy, particularly for breast and lung cancer, which can damage the pericardium;
• certain medications, like penicillin and some chemotherapy drugs.

Pericarditis can be acute, recurring and chronic.

• Acute pericarditis occurs suddenly and often appears after the flu-like symptoms. Its symptoms do not last more than 3 months and with proper treatment they normally resolve within a week;
• Recurring pericarditis is diagnosed when a person has repeated episodes of acute pericarditis;
• Chronic pericarditis is when symptoms last longer than 3 months and lead to complications.

Complications of pericarditis may disrupt the normal heart rhythm and function and sometimes, although very rarely, may lead to death. They include:

Cardiac tamponade when excess of fluid builds up in the pericardium, putting pressure on the heart and not allowing it to fill properly. This leads to a dramatic drop in blood pressure since less blood leaves the heart. If not promptly treated, cardiac tamponade can be fatal.

Constructive pericarditis when the pericardium tissue becomes hardened through scaring due to long-term inflammation. The loss of elasticity makes the sac around the heart tight and rigid, keeping it from working properly. The condition often leads to shortness of breath and severe leg and-abdominal swelling.

The diagnosis is usually made on recent medical history and after listening to the heart, since pericarditis often changes the sound of the heartbeat to distinctive grating or rasping sound. A blood test may be performed to detect infections and the fluid from around the heart may be drained with a needle so it can be tested too.

An electrocardiogram is usually performed since pericarditis changes electrical activity of the heart. If a person has additional symptoms that may be associated with other diseases, further testing may include a chest X-ray, echo-cardiogram, MRI or CT scan.

Treatment typically involves medications, although in rare cases surgery may be performed. Usually pericarditis is treated with NSAIDs to reduce the inflammation of the pericardium and relieve chest pain. It also responds to treatment with pain relievers, such as Ibuprofen.

Sometimes patients are given Colchicine, alone or together with NSAIDs. It helps to reduce inflammation by killing certain cells and decreases the chances for the condition to recur.

If symptoms fail to respond to the above-mentioned drugs or if there is fluid build-up, corticosteroids, such as Prednisone, are prescribed to block the effects of the immune system.

If the condition is caused by bacterial infection, antibiotics may be used.

In severe cases of pericarditis or when cardiac tamponade is suspected, surgically removing the pericardium may be used. It is usually the last resort as it is relatively risky.

However, most cases of pericarditis are mild and usually clear up with simple treatment and rest or on their own. It may take from few days to months to recover from the disease. Prompt and proper treatment leads to full recovery for most patients. Early diagnosis and care reduces the risk of getting the disease again as well as helps to avoid long-term complications.