Pericarditis-inflammation of your heart muscle’s protector, the pericardium, can be a one-time problem or a recurring aggravation which can interfere with the normal functions of your heart.
The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. It protects the heart from infection or malignancy and holds your heart in the chest wall. It is a fierce protector.
It also prevents the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.
Pericarditis is an inflammation of the pericardium.
This condition is usually acute – meaning that it develops suddenly and is intense. In fact, it may last up to several months.
If you could see and touch the pericardium in the throes of pericarditis, the membrane around the heart would look red and swollen, like the skin around a cut that becomes inflamed.
Most cases of pericarditis are diagnosed in men aged 20 to 50 (but it can occur at any age). Pericarditis can also affect women.
Left untreated, pericarditis can become a life-threatening condition.
➡ You can develop a Pericardial Effusion, which is an abnormal accumulation of fluid in the pericardial cavity.
➡ Due to the limited amount of space in the pericardial cavity, fluid accumulation would lead to increased intra-pericardial pressure, known as cardiac tamponade, which impairs the heart’s ability to function.
- Chest pain
- Difficulty breathing
- Heart palpitations
- Rapid breathing
If you develop symptoms of constrictive pericarditis, including:
- shortness of breath
- swelling of the legs and feet
- fluid retention
- heart palpitations, and
- severe swelling of the abdomen, you should make an appointment with your cardiologist for an evaluation.
Chest pain symptoms associated with pericarditis can be described as:
- Sharp and stabbing (caused by the heart rubbing against the pericardium)
- They may increase with coughing, swallowing, deep breathing or lying flat
- They can be relieved by sitting up and leaning forward
You also may feel the need to bend over or hold your chest to breathe more comfortably.
Other symptoms include:
- Pain in the back, neck or left shoulder
- Difficulty breathing when lying down (very commonly seen)
- A dry cough
- Anxiety or fatigue
In some people, pericarditis can cause swelling of the feet, legs or ankles. This swelling may be a symptom of constrictive pericarditis, a serious type of pericarditis.
➡ The then thick, rigid pericardium constricts the heart’s normal movement so that it cannot expand normally as it fills with blood.
➡ The heart may be compressed by this process, which may cause blood to back up into the lungs, abdomen, and legs, as well as result in swelling.
The heart chambers (the atria and ventricles) don’t fill up with enough blood.
The blood then backs up behind the heart, causing symptoms of heart failure:
- Shortness of breath
- Swelling of the legs and feet
- Fluid retention
- Disturbances in the heart’s normal rhythm (Arrhythmias)
These symptoms should improve once the constrictive pericarditis is treated.
Constrictive pericarditis can often be treated with a diuretic, such as Lasix (furosemide), to eliminate or prevent the fluid retention.
- If you develop a heart rhythm problem, you may need to take a medication to treat the irregular rhythm for as long as the constrictive pericarditis lasts or until your heart rhythm returns to normal.
When none of these treatments are effective, a pericardiectomy may be needed to surgically remove the stiffened areas of the pericardium.
If you have any symptoms of acute pericarditis, it is important to call your doctor right away.
Cardiac tamponade resulting from a pericardial effusion can be life-threatening and is a medical emergency requiring emergent drainage of the fluid with a catheter.
➡ Although there are a number of causes, pericarditis is often a complication of a viral infection (viral pericarditis) – usually a gastrointestinal virus, or rarely the flu virus or AIDS.
It may also be caused by:
➡ a bacterial infection (bacterial pericarditis), a fungal infection (fungal pericarditis) or a parasitic infection (parasitic pericarditis).
With no shortage of instigators, other causes may include:
- Injury to the chest such as after a car accident (traumatic pericarditis)
- Kidney failure (uremic pericarditis)
- Genetic diseases such as Mediterranean Fever
And rarely, although it does happen, taking medications that suppress the immune system (Such as corticosteroids like Prednisone).
The risk of pericarditis is greater after a heart attack or after heart surgery (Dressler’s syndrome), radiation therapy or a treatment, such as cardiac catheterization or ablation.
Your doctor will start with an evaluation of your symptoms:
➡ The sharp pain in the chest and back of the shoulders, often in one or both arms, plus the difficulty breathing are major clues that you may have pericarditis.
Your doctor will ask you about your medical history, such as whether you’ve had a recent viral illness.
- Hopefully, he/she would already know, or you would report, any previous heart surgery or current diseases, such as lupus or kidney failure, that may increase your risk of pericarditis.
➡ During a physical exam, the doctor will listen to your heart with a stethoscope because Pericarditis often causes a rubbing or creaking sound, called a “pericardial rub,” that is produced by the rubbing of the inflamed lining of the pericardium.
- This is best heard when the patient leans forward while holding his or her breath, and when breathing out.
Depending on how severe the inflammation is, your doctor may also hear crackles in the lungs (they sound like crinkling newspapers) which are signs of fluid in the space around the lungs or excess fluid in the pericardium.
Specialty centers such as the one at the Cleveland Clinic have imaging specialists at the Center for the Diagnosis and Treatment of Pericardial Diseases. They often use a variety of approaches to accurately diagnose pericarditis and to detect any complications.
Diagnostic tests may include:
• Chest X-ray: They show evidence of enlargement of the heart and congestion of the lungs.
• Electrocardiogram (ECG or EKG): Shows changes in your normal heart rhythm that may indicate you have pericarditis.
In about half of the patients with pericarditis, the heart rhythm goes through a sequence of four distinct patterns, but all patients with pericarditis will have some of the changes.
• Echocardiogram (echo): Shows the heart function and may show evidence of fluid or pericardial effusion (an escape of fluid into a body cavity), in this case, the heart.
It will also show the classic signs of constrictive pericarditis when present (including stiffening or thickening of the pericardium that constricts the heart’s normal movement).
• Cardiac MRI and CT scans: Show excess fluid in the pericardium or signs of pericardial inflammation using a special imaging agent.
These tests may also show a thickened pericardium or compression of the heart from the thickened pericardium.
• Cardiac catheterization: Provides information about the filling pressures within the heart in order to confirm a diagnosis of constrictive pericarditis.
• Laboratory (blood) tests: Can be used to make sure you’re not having a heart attack, to evaluate the heart’s function, test the fluid in the pericardium and determine the underlying cause of the pericarditis.
Other laboratory tests may include evaluation of autoimmune diseases which may be an underlying cause.
Treatment for acute pericarditis (sudden onset) may include medication for pain and inflammation, such as nonsteroidal anti-inflammatory drugs, including ibuprofen in large doses.
➡ Depending on the cause of your pericarditis, your doctor may prescribe an antibiotic (for bacterial pericarditis) or an antifungal medication (for fungal pericarditis).
➡ If your symptoms last longer than two weeks or recur over subsequent months, your doctor may prescribe an anti-inflammatory drug called Colchicine in combination with the ibuprofen. It can help prevent pericarditis from recurring weeks or even months later.
➡ When high doses of ibuprofen are prescribed, your doctor may also prescribe medications to offset gastrointestinal symptoms.
If you’re taking high doses of nonsteroidal anti-inflammatory drugs, (NSAIDs such as Aspirin, Ibuprofen, Aleve)you should be monitored with frequent follow-up appointments to evaluate changes in kidney or liver function.
Most people with pericarditis are only prescribed the medications needed to clear up the inflammation. Surgery is rarely necessary.
However, if the fluid builds up in the pericardium, compressing the heart and preventing its normal functions, a procedure called Pericardiocentesis may be required. In this procedure excess fluid is drained with a catheter.
- If the fluid cannot be drained with a needle, then a surgical procedure called a pericardial window is performed.
Surgery may be needed for some patients with constrictive pericarditis.
Rarely, but depending on the severity of the condition and the patient’s pain, a Pericardiectomy may be necessary. It involves the removal of a portion of the pericardium.
In most people, pericarditis lasts for up to three months then goes away and does not come back.
After you recover from the illness, you should be able to return to your normal activities without any reason for concern.
Your doctor will talk to you about what you can expect and any activity limitations depending on your age, health, activity level and the cause of your pericarditis.
The better physical health you’re in, the better your outcomes.
Occasionally the attacks recur every few months and anti-inflammatory medications may be needed for years to manage the symptoms.
Take care, take care, take care of your heart. Prevention is always the best route.
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Center for the Diagnosis and Treatment of Pericardial Diseases