Pericarditis

Pericarditis is a medical condition characterized by inflammation of the pericardium, the double-layered sac surrounding the heart. This sac consists of two layers: the visceral pericardium, which adheres to the heart's surface, and the parietal pericardium, which is the outer layer. Between these layers is the pericardial space, containing a small amount of fluid that lubricates the heart and allows it to move within the chest cavity with minimal friction.

Causes:

The cause of pericarditis is often difficult to determine and may be idiopathic (of unknown origin). However, several factors are known to contribute to its development:

• Infections: Viral infections are the most common cause. Common culprits include Coxsackievirus, Echovirus, Adenovirus, and Influenza virus. Bacterial, fungal, and parasitic infections are less frequent causes.
• Autoimmune Disorders: Conditions like systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, and other autoimmune diseases can trigger pericarditis.
• Post-Myocardial Infarction: Pericarditis can occur as a complication following a heart attack (myocardial infarction). This can manifest as early pericarditis (within a few days) or Dressler's syndrome (weeks to months later, considered an autoimmune response to damaged heart tissue).
• Trauma: Chest injuries, including those sustained during surgery, can lead to pericarditis.
• Cancer: Malignancies, including lung cancer, breast cancer, lymphoma, and leukemia, can sometimes involve the pericardium and cause inflammation.
• Kidney Failure: Uremia associated with kidney failure can irritate the pericardium.
• Radiation Therapy: Radiation to the chest can sometimes damage the pericardium and lead to inflammation.
• Certain Medications: Some medications, such as hydralazine, isoniazid, procainamide, and phenytoin, have been associated with drug-induced lupus-like syndrome and pericarditis.

Symptoms:

The most common symptom of pericarditis is sharp, stabbing chest pain, which may:

• Be located behind the breastbone or on the left side of the chest.
• Worsen with deep breathing, coughing, swallowing, or lying down.
• Improve when sitting up and leaning forward.
• Radiate to the neck, shoulder, back, or abdomen.

Other possible symptoms include:

• Fever
• Fatigue
• Cough
• Shortness of breath (dyspnea)
• Heart palpitations
• Swelling in the legs or abdomen (in cases of constrictive pericarditis or pericardial effusion)

Diagnosis:

Diagnosis of pericarditis typically involves:

• Medical History and Physical Examination: The doctor will inquire about symptoms and perform a physical exam, listening for characteristic heart sounds like a pericardial friction rub (a scratching or grating sound).
• Electrocardiogram (ECG or EKG): ECG changes are often present in pericarditis, including ST-segment elevation and T-wave inversion.
• Blood Tests: Blood tests can help identify signs of inflammation (elevated ESR, CRP), infection (white blood cell count), and cardiac damage (troponin).
• Chest X-Ray: A chest X-ray may reveal an enlarged heart silhouette if there is a significant pericardial effusion.
• Echocardiogram: An echocardiogram uses sound waves to create images of the heart. It can detect pericardial effusion (fluid around the heart) and assess heart function.
• Cardiac MRI or CT Scan: In some cases, a cardiac MRI or CT scan may be used to evaluate the pericardium in more detail, especially when other imaging modalities are inconclusive.
• Pericardiocentesis: In rare cases, a pericardiocentesis (needle aspiration of fluid from the pericardial space) may be performed to analyze the fluid for signs of infection, cancer, or other abnormalities.

Treatment:

Treatment for pericarditis depends on the underlying cause and the severity of the symptoms. Common treatments include:

• Pain Relief: Over-the-counter or prescription pain relievers, such as ibuprofen or aspirin, are often used to reduce pain and inflammation.
• Colchicine: Colchicine is an anti-inflammatory medication that is often used in conjunction with pain relievers to treat pericarditis and prevent recurrence.
• Corticosteroids: Corticosteroids, such as prednisone, may be used in cases of autoimmune pericarditis or when other treatments are ineffective. However, they have potential side effects and are typically reserved for more severe or refractory cases.
• Antibiotics, Antifungals, or Antivirals: If the pericarditis is caused by an infection, appropriate antimicrobial medications will be prescribed.
• Pericardiocentesis or Pericardiectomy: In cases of large pericardial effusion causing cardiac tamponade (compression of the heart), pericardiocentesis may be necessary to drain the fluid. In cases of constrictive pericarditis (scarring and thickening of the pericardium), a pericardiectomy (surgical removal of the pericardium) may be required.

Prognosis:

The prognosis for pericarditis is generally good, especially when the underlying cause is identified and treated promptly. Most cases resolve within a few weeks to months. However, pericarditis can recur, and some people may develop chronic pericarditis or complications such as constrictive pericarditis or cardiac tamponade. Regular follow-up with a healthcare provider is important to monitor for these complications.