Pericarditis – types, causes, symptoms, diagnosis. What is the treatment of pericardial inflammation?

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Pericarditis is an inflammation of the pericardial sac in which the heart muscle is located. Its causes may be, among others viral infections, kidney failure and hypothyroidism. Pericarditis is treated with anti-inflammatory drugs and steroids. Ignoring pericarditis can have serious consequences, including cardiac tamponade.

What is pericarditis?

Pericarditis is an inflammation that attacks the outer layer of the heart, i.e. the pericardial sac in which the heart muscle is placed. The pericardial cavity is located between the inner and outer layers of the pericardial sac and is filled with a small amount of fluid. This fluid is designed to reduce friction when the heart beats. In addition, the pericardial sac is designed to prevent too much expansion of the heart cavities during systole and diastole. It also keeps the heart in the right place in the mediastinum. However, its most important task is to prevent any kind of inflammation. It can appear as a complication of other common viral diseases, such as the flu. Ignoring pericarditis can have very serious consequences, including cardiac tamponade, which is life-threatening.

Pericarditis – symptoms

When it comes to pericarditis, the first symptom is ache located in the area of ​​the heart, usually aggravated by coughing, moving and swallowing – these symptoms indicate that the walls of the pericardial sac are rubbing against each other. Pain can take the form of severe pain or pressure, and it can radiate to the abdomen, shoulders, and neck. Due to weakness, the patient in a sitting position leans forward. An inflammatory exudate collects in the pericardial sac that compresses the heart. Then you may experience shortness of breath, dry cough and a fast heart beat. Pericarditis rarely occurs, usually the ailment spreads to other layers of the heart, hence pericarditis is not rarely accompanied by myocarditis. Concomitant symptoms may include low-grade fever, chills and general weakness.

The causes of pericarditis

Among the causes that lead to pericarditis, we can mention the following:

1. viral infections – influenza, HIV, bacteria, fungi or parasites (these cause pericarditis mainly in people with significantly weakened immunity);
2. cancer patients;
3. myocardial infarction;
4. systemic diseases of connective tissue – inflammation occurs especially in patients diagnosed with lupus, RA or chronic renal failure;
5. exposure to ionizing radiation;
6. Hypothyroidism;
7. cardiac catheterization or the use of certain measures, e.g. diuretics.

Note: In many patients, the cause of pericarditis cannot be determined. We are talking then about idiopathic pericarditis.

Pericarditis – types

Inflammation can affect the pericardium itself, but also other layers of the heart – there are the following types of inflammation:

1. isolated pericarditis – only affects the pericardial sac;
2. exudative inflammation, where a large amount of inflammatory exudative fluid accumulates in the pericardial sac. Then, the fluid accumulated in the pericardial sac compresses the heart muscle from the outside, making the diastolic activity of the ventricles difficult to some extent.

Pericarditis – diagnosis

The diagnosis of pericarditis requires observation of the heart function as well as laboratory, electrocardiographic and radiological tests. After conducting a medical interview with the patient, the doctor begins auscultation with a stethoscope. In patients with endocarditis, a typical pericardial rub may be heard.

Additional examinations ordered by a specialist are;

1. The echo of the heart;
2. ECG;
3. Chest x-ray;
4. blood tests (in patients with pericarditis, the concentration of C-reactive protein is increased and the increase in ESR is accelerated);
5. pericardial fluid test – helps find the cause of inflammation.

Treatment of pericarditis

Treatment should be carried out initially in a hospital, further convalescence may take place at home. Thus, the treatment of pericarditis consists of:

1. patients taking anti-inflammatory preparations;
2. the use of steroids (in case of increased inflammation);
3. administering antibiotics – if bacteria are the cause of pericarditis.

In addition, it is recommended to perform the procedure in patients who have accumulated large amounts of fluid in the pericardial sac pericardiocentezy. This procedure involves puncturing the pericardial sac and then releasing the fluid inside. Failure to do so may result in cardiac tamponade in the patient.

It may be necessary in patients with constrictive pericarditis pericardectomy (surgical removal of the pericardium). The perioperative mortality ranges from 6 to 12%. This is due to the difficult separation of the hypertrophied pericardium from the heart muscle in patients with advanced disease.

Pericarditis – complications

The complications of pericarditis include:

1. cardiac tamponade – this condition is characterized by the accumulation of fluid in the pericardial sac to such an extent that it begins to put pressure on the hearts. For this reason, it is not able to pump enough blood, which in turn poses a threat to the patient’s life;
2. constrictive pericarditis – occurs as a result of pericardial atresia and thickening, as a result of multiple or chronic pericarditis. The pericardial sac becomes hard and pumping blood becomes much more difficult.

Prognosis in pericarditis

The prognosis of pericarditis depends mainly on its origin. As for the viral origin, which is the most common – prognosis is good, but relapse is possible even in 50%. It is a bit worse in pericarditis caused by neoplastic causes. In this case, the prognosis is poor and patients survive for about three months. Purulent bacterial inflammation in untreated patients is also considered fatal (although even treated cases have a certain mortality rate). The disease of tuberculosis can lead to constrictive pericarditis, which leads to loss of elasticity of the pericardial sac. Then the relaxation of the heart ventricles is limited, and as a consequence, it causes abnormalities in blood filling and gives symptoms of failure. In such cases, pericardiectomy (surgical removal of the pericardial sac) is performed, but the procedure is also characterized by high mortality, even 12%.

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