The pericardium is one of the most important areas of the body for the function of the heart.
It is a double-layered resistant membrane that surrounds the heart. The space between the two layers contains a liquid (pericardial fluid).
The pericardium has several functions, the most important are:
- envelope of the heart in the chest cavity;
- Prevention of excessive expansion of the heart, which can occur due to an increase in cardiac output.
Excessive accumulation of pericardial fluid is called pericardial effusion.
There are two main causes of the development of pericardial effusion. The first is inflammation of the pericardium, known as pericarditis, the second is a buildup of blood in the pericardium.
It is often caused by inflammation of the pericardium.
However, there are cases when there is no inflammation.
Pericarditis is not contagious.
It can occur together with myocarditis, which is inflammation of the heart muscle.
Contents
Classification of pericarditis
There are 3 main types of pericarditis:
- Acute pericarditis: symptoms last less than three months (usually they pass within a week under therapy).
- Recurrent pericarditis: with repeated episodes of acute pericarditis.
- Chronic pericarditis: a complication of pericarditis in which symptoms persist for more than three months.
Other types of pericarditis
- Uremic pericarditis is a complication of renal insufficiency and can also occur in patients receiving hemodialysis.
- Pericarditis epistenocardica is an inflammation of the pericardium that occurs after myocardial infarction.
- Pericarditis fibrinosa consists of deposits of fibrin layers and occurs after surgery, after a heart attack or due to diseases of connective tissue.
- Pericarditis exsudativa serosa characterized by an effusion containing a lot of pus or albumin.
- Neoplastic pericarditis is provoked by a tumor on the pericardium or by metastases.
- Dressler syndrome is a type of pericarditis characterized by a reaction of the immune system after damage to the heart tissue or pericardium.
It can occur postoperatively, post-traumatically or as a consequence of a heart attack.
The symptoms of Dressler syndrome consist of chest pain similar to that of a heart attack and fever.
Thanks to recent improvements in the treatment of myocardial infarction, Dressler syndrome is less common than before. Nevertheless, this disease can occur repeatedly in affected people.
Causes of pericarditis
Causes of pericarditis can be:
- Viral infections such as cold, viral meningitis, cytomegalovirus, glandular fever, lip or genital herpes, influenza, hepatitis C and HIV/AIDS
- Bacterial or purulent pericarditis as a possible complication of an infectious disease such as pneumonia, bronchitis or tuberculosis
- Rheumatoid arthritis, lupus and other autoimmune diseases
- Renal failure
- Hypothyroidism (hypothyroidism)
- Heart damage caused by myocardial infarction
- Thoracic trauma
- Cardiac surgery (is a cause of pericarditis in children)
- Tumor therapies, such as radiotherapy
- Metastases (due to lung tumor or breast cancer, leukemia, etc.)
- Heart failure leading to pleural effusion and pericardial effusion
- Some medications
In addition, there are some cases in which the disease is idiopathic, i.e. for which no cause can be determined.
Symptoms of pericarditis
Usually, acute pericarditis causes a stabbing chest pain at the back of the sternum or on the left side of the thorax.
Since the pain also radiates to the left shoulder and neck, most people think it is a myocardial infarction. The pain is aggravated when coughing, deep inhalation, eating or lying down.
Some common symptoms that indicate the onset of pericardial effusion include:
- Acute stabbing pain felt behind the sternum, usually on the left side of the chest. The pain does not remain localized and radiates to the left shoulder and neck.
- Actions such as coughing, laughing, sneezing, lying flat or eating can make the pain worse. When sitting, the symptoms decrease.
- Difficulty breathing in a lying position and also when inhaling.
Symptoms that may occur along with pericarditis include dizziness, mild fever, rapid heartbeat, and anxiety for no particular reason. In some cases, swollen legs or a swollen abdomen, nausea and dry cough may occur.
Complications of pericarditis
Cardiac tamponade and chronic constrictive pericarditis are two serious complications of pericarditis.
A cardiac tamponade occurs when too much fluid accumulates in the pericardium (serous sac that surrounds the heart).
The excessive fluid puts some pressure on the heart and prevents blood filling. As a result, the heart pumps a smaller amount of blood and there is a sudden drop in arterial blood pressure.
If not treated, the cardiac tamponade can have fatal consequences.
Chronic adhesive or constrictive pericarditis is a rare condition that develops over a long period of time. This leads to the formation of fibrous tissue throughout the pericardium.
This membrane becomes rigid and can no longer move properly. Over time, fibrous tissue encloses the heart and prevents its proper functioning.
What complications can occur with untreated pericarditis?
The excessive fluid that accumulates around the heart begins to press against the organ. Without therapy, this strong pressure can prevent the complete blood filling of the heart chambers.
This heart disorder is called tamponade.
The direct consequence of this malfunction is poor circulation and lack of oxygen. This can be a dangerous situation for the person concerned.
It is therefore advisable to look for an initial medical intervention and therapy.
Pericarditis is an inflammation of the pericardium, which is the outer lining of the heart.
Diagnosis of pericarditis
The doctor must know the clinical picture and symptoms of the patient, after which he will conduct a physical examination.
Chronic pericarditis is a recurrent disease. It is therefore important for the patient to tell the doctor if it is a relapse.
Diagnostic examinations in pericarditis
First of all, it is necessary to undergo a general medical examination.
The doctor listens to the patient’s heart with the stethoscope. If the heart is surrounded by fluid, he may hear an acute abnormal sound.
If there is too much fluid around the heart, the heart murmur seems to come from a certain distance.
At the end of the check-up, the doctor may prescribe certain examinations to the patient:
- Radiography: The chest X-ray is the first examination that helps to clarify the problem. A broadened structure of the heart is observed when it is surrounded by fluid.
- Electrocardiogram: It is used to study the electrical activity of the heart. The ECG curves created by the pressure on the heart due to the accumulation of fluid help diagnose this condition.
- Echocardiogram: This is the most commonly used diagnostic examination to detect pericardial effusion. Through the echocardiogram, the doctor is able to examine the images of the heart in real time.
- Blood test: The doctor may request a blood test to confirm the diagnosis and determine the cause of pericarditis.
For example, increased troponin may be caused by pericarditis. - Other diagnostic tests: Equipment tests such as CT (computed tomography) and MRI (magnetic resonance imaging) can be pericarditis, but they are usually not used to diagnose this problem.
Therapy of pericarditis
Therapy of pericarditis depends on the following factors:
- Causes of pericardial effusion
- Degree of fluid accumulation
- Severity of the disease (it can limit the functioning of the heart)
After considering all these factors, doctors choose the most appropriate treatment for the patient.
If there is no immediate risk of worsening the disease, medication can be used to treat the inflammation of the pericardium.
This includes nonsteroidal anti-inflammatory drugs such as indomethacin or ibuprofen, which are also safe during pregnancy. In addition, the doctor may prescribe steroids, diuretics, other heart failure medications and/or antibiotics to fight the infection.
Colchicine helps reduce the inflammation that caused pericarditis.
Doctors may opt for surgery if these drugs are ineffective or if the disease causes or may cause a tamponade.
In the acute phase, rest is important, so sports must be avoided.
Surgery
Surgical interventions include:
Pericardiocentesis with ultrasound assistance: It is often performed and is a safe and effective medical procedure used to remove or drain excess fluid from the pericardium.
Video-assisted thoracoscopy: It is performed under general anesthesia and is used for visual assessment of the pericardium. This procedure drains and prevents the accumulation of excessive fluids.
Intrapericardial sclerotherapy: In this procedure, a solution is introduced between the pericardial layers to seal them. It is usually used for pericardial effusion caused by cancer.
Pericardectomy: This operation involves the complete or partial removal of the pericardium. However, it is only used in very complicated cases of fluid retention.
After the operation, it is necessary to pay attention to a light diet low in salt and sugar in order to recover faster.
In addition, it is recommended to quit smoking because smoking causes a lot of damage that can prolong recovery times.
How long does the disease last? Prognosis
If pericarditis is mild, the recovery time is about 2-3 months, but in severe cases it can lead to the death of the person concerned.
Pericarditis can recur, in which case it becomes chronic.
