Pericarditis – Types, Causes and Treatment

Definition

Pericarditis is an inflammation of the pericardium. It is usually acute – it develops suddenly and may last up to several months. The condition usually clears up after 3 months, but sometimes attacks can come and go for years. When you have pericarditis, the membrane around your heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. It can affect anyone, but it is most common in men aged 16 to 65.

Prevalence

Acute pericarditis is the admitting diagnosis in 0.1% of hospital admissions and 5% of admissions with chest pain. It occurs more commonly in men than in women.

Types

There are several types, and each one of them is identified by different symptoms.

Acute pericarditis: This type starts suddenly, but patients are likely to observe pain and other signs for two to three weeks. However, the possibility of it occurring again is likely. It can be difficult to evaluate the difference between the pain because of a heart attack and acute pericarditis.

Recurrent pericarditis: After you have faced an episode of acute pericarditis, there is a possibility of recurrent pericarditis. It occurs about four to six weeks after you have suffered from acute pericarditis, and you are likely to observe any symptoms in between the time frame.

Incessant pericarditis: This type lasts from four to six weeks and does not last more than three months. You can observe continuous symptoms like chest pain.

Chronic constrictive pericarditis: This is a type it develops slowly and has a longer duration than incessant pericarditis, like more than three months.

Pericarditis risk factors

It can happen at any age, but men ages 20 to 50 are more likely to develop it.

The cause of pericarditis is often unknown. However, some factors are known to trigger pericarditis, such as:

• A past heart attack
• Autoimmune diseases
• Trauma or injury from an accident
• Certain bacterial, viral and fungal infections
• Kidney failure
• Rarely, certain medications such as phenytoin to treat seizures and procainamide to treat irregular heartbeats

Causes of Pericarditis

Causes of acute pericarditis include

• Infection (viral, bacterial, parasitic, or fungal and, in people with AIDS, tuberculosis, or aspergillosis)
• Heart attack
• Heart surgery (postpericardiotomy syndrome)
• Systemic lupus erythematosus (lupus)
• Rheumatoid arthritis
• Kidney failure
• Chest injury
• Cancer (such as leukemia, breast cancer, lung cancer, or, in people with AIDS or Kaposi sarcoma)
• Rheumatic fever
• Radiation therapy
• Drugs, including warfarin and heparin (anticoagulants), penicillin, procainamide (a drug used to treat abnormal heart rhythms), and phenytoin (an antiseizure drug)
• Unknown (idiopathic or nonspecific pericarditis)

In people who have AIDS, a number of infections, including tuberculosis and aspergillosis, may result in pericarditis. It is due to tuberculosis (tuberculous pericarditis) accounts for less than 5% of cases of acute pericarditis in the United States but accounts for the majority of cases in some areas of India and Africa.

After a heart attack, acute pericarditis develops during the first day or two in 10 to 15% of people and after about 10 days to 2 months in 1 to 3% (subacute pericarditis). Subacute pericarditis is caused by the same disorders that cause acute pericarditis.

Symptoms of Pericarditis

The following are the most common symptoms. However, each child may experience symptoms differently. Symptoms may include chest pain that:

• Can be felt especially behind the breastbone, and sometimes beneath the clavicle (collarbone), neck, and left shoulder
• Is a sharp, piercing pain over the center or left side of the chest that increases as the child takes a deep breath
• A low-grade fever
• Irritability
• Fatigue
• Loss of appetite
• Irregular heartbeat

Children may not be able to describe that they have “chest pain” or be able to explain how they feel. Sometimes, non-specific symptoms such as irritability, loss of appetite, or fatigue will be all that the child is able to express.

The symptoms may resemble other medical conditions or heart problems. Always consult your child’s physician for a diagnosis.

Pericarditis complications

Some of the dangerous complications include:

Cardiac tamponade – fluid builds up between the two layers of the pericardium. The heart is compressed and can’t function properly. This requires immediate attention and can be fatal.

Abscess – A build-up of pus either within the heart or in the pericardium

Spread of infection – Aas with any infection, the infection can spread to other areas

Constrictive pericarditis – The pericardium is scarred by the inflammation. Scar tissue doesn’t stretch, so the heart can’t function properly.

Diagnosis and test

If your healthcare provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of is a pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may also be heard.

Your healthcare provider may also check for pulsus paradoxus. This is when your blood pressure drops when you take a deep breath. The changes in the pressure in your chest keep blood from returning from your body and entering your heart.

Along with a health history and physical exam, you may also need certain tests. These may include:

Echocardiogram (echo): This test uses sound waves to check your heart’s size and shape. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin over the heart. The echo can show how well your heart is working and whether fluid has built up around your heart.

Electrocardiogram (ECG): This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.

Chest X-ray: An X-ray may be done to check your lungs and see if your heart is enlarged.

Cardiac MRI: This is an imaging test that takes detailed pictures of the heart. It may be used to look for thickening or other changes in the pericardium.

Cardiac CT: This type of X-ray takes a clear, detailed picture of your heart and pericardium. It may be used to help rule out other causes of chest pain.

Blood tests: Certain blood tests can help rule out other heart problems, such as heart attack, and can tell the doctor how much inflammation there is in your body.

Treatment and medications

Your doctor will talk with you about your symptoms, answer your questions, and work with you to develop a personalized treatment plan. Following your treatment plan can help you recover within a few weeks and avoid another episode.

With rest and non-prescription anti-inflammatory medications to reduce swelling and irritation, many instances of pericarditis go away within a few days or weeks.

If your pericarditis is severe, or if you develop complications, your doctor may recommend additional treatment. Your doctor may also treat the underlying cause of your pericarditis, if it can be identified.

The treatments may include:

• Surgery to relieve pressure by removing fluid buildup or removing part or all of the pericardium
• Anti-inflammatory medications such as prednisone
• Antibiotics, if it is caused by a bacterial infection
• Prescription pain relievers

Surgery to treat pericarditis isn’t common. It’s usually only recommended if the inflammation of your pericardium is so severe that it prevents your pericardium from working as it should. Surgery may also be considered if initial treatments don’t achieve the desired results, and your pericarditis becomes chronic.

Prevention of Pericarditis

Because pericarditis can be the result of so many very different illnesses, there are no routine guidelines to prevent the condition. You can help prevent pericarditis caused by infections by practicing good hygiene, especially washing your hands often, and by keeping up with recommended immunizations.

To prevent pericarditis caused by heart attack, you can reduce your risk of coronary artery disease by not smoking, eating a healthy diet, exercising regularly, lowering LDL cholesterol and controlling blood pressure.

To reduce your risk of trauma-related pericarditis, you should wear a seat belt whenever you drive and wear appropriate chest-protecting equipment when you play contact sports.