Pericarditis is inflammation of the outer layer of the heart - the so-called pericardial sac. Pericarditis can be a complication of common viral diseases, such as the flu, and if left untreated it can lead to, inter alia, to a life-threatening cardiac tamponade. What are the other causes and symptoms of pericarditis? What is the treatment?

What is pericarditis?

Pericarditisis an inflammation of the thin, smooth membrane surrounding the heart - a kind of sac (the so-calledpericardial sac ) in which my heart. There is a narrow space (the pericardial cavity) between the inner and outer layers of the pericardial sac that is filled with a small amount of fluid.

Its task is to reduce friction when the heart beats. In addition, the pericardial sac prevents excessive expansion of the heart cavities during its diastole and allows the correct position of the heart in the mediastinum to be maintained. But most importantly - due to the fact that the pericardium tightly covers the whole heart, it creates a protective barrier against injury or the spread of the inflammatory process.

Inflammation usually causes an increased amount of inflammatory exudate to accumulate in the pericardial sac. In medical terminology, it isexudative pericarditis.

Rarely, only the pericardium itself becomes inflamed. Usually, inflammation extends to other layers of the heart, so pericarditis may be accompanied by inflammation of the heart (myocardium) or endocarditis. Inflammation can spread to other parts of the body as well.

Pericarditis - causes

The most common causes of pericarditis are:

  • infections - most often viruses (e.g. enteroviruses, HIV or influenza virus), bacteria, fungi, parasites (they rarely cause pericarditis and usually in people with weakened immunity, e.g. in AIDS patients)
  • heart attack - US studies show that pericarditis occurs in about 10 percent of people after a heart attack
  • cancer
  • systemic diseases of connective tissue - patients with systemic scleroderma, lupus and rheumatoid arthritis are particularly exposed to pericarditis
  • chronic renal failure (in advanced stage) - can lead touremic pericarditis
  • hypothyroidism
  • ionizing radiation

Pericarditis can also be a complication of cardiac surgery, cardiac catheterization and, rarely, a side effect of certain medications, such as diuretics.

However, in most cases the cause of the pericarditis cannot be found. Then we are talking aboutidiopathic pericarditis.

Pericarditis - symptoms

Initially, when there is not as much fluid in the pericardial sac, the dominant symptom of inflammation is chest pain, which:

  • may be in the form of severe pain or pressure
  • is located on its left side, behind the sternum or in the precordial area
  • can radiate to the abdomen, back, shoulder and even neck
  • is usually worsened by coughing, moving and swallowing, and often when lying down
  • weakens when sitting and leaning forward

Later, when fluid accumulates in the pericardial sac in a significant amount and there is pressure on the heart, there is a dry cough, shortness of breath, faster than usual fatigue, increased heart rate.

Accompanying symptoms are high fever, chills and general weakness.

Pericarditis - diagnosis

After interviewing the patient, the doctor auscultates him with a stethoscope. Characteristic pericardial rubbing is heard in the case of pericarditis.

In addition, ECG and ECHO tests of the heart are ordered. Chest X-rays and blood tests are also helpful (with pericarditis, an increase in the concentration of C-reactive protein and an accelerated ESR).

In addition, a pericardial fluid test is usually performed to determine the cause of the pericarditis.

Pericarditis - treatment

The patient is administered anti-inflammatory drugs - acetylsalicylic acid and / or colchicine. In cases of severe inflammation, steroids may be necessary. Therapy also includes other medications (depending on what is the cause of the disease). For example, antibiotics are given for battery pericarditis.

If there is an accumulation of a large amount of fluid in the pericardial sac, pericardiocentesis is necessary, which is a procedure that punctures the pericardial sac to release the fluid in it. Failure to do so may result in cardiac tamponade.

Treatment should initially take place in a hospital. Further recovery can be carried out at home.

In the case of clampingpericarditis, you may need a pericardiectomy, which is the surgical removal of the pericardium. However, in this case, the perioperative mortality is 6-12%. It is associated with difficulties in separating the hypertrophied pericardium from the heart muscle in advanced cases of the disease.

Important

Pericarditis - complications

Complications of untreated pericarditis are:

  • cardiac tamponadein which fluid builds up in the pericardial sac to the point where it puts a lot of pressure on the heart. As a consequence, it cannot pump enough blood, which is a life-threatening condition
  • constrictive pericarditis- occurs when the pericardial thickening and atresia occurs, most often as a result of chronic or repeated pericarditis. Then the pericardial sac becomes stiff and it is difficult for the heart to pump blood through the heart

Category:

Cardiology