Pericarditis

Swelling and irritation of the pericardium, the thin sac-like membrane surrounding the heart, is referred to as Pericarditis. Pericarditis causes sharp chest painwhen the irritated layers of the pericardium rub against oneanother.

Causes

Under normal circumstances, the two-layered pericardial sac that surrounds our heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting friction causes chest pain.

In most cases, doctors either are unable to either determine a cause or suspect the causeto resulted bea viral infection.

In many cases, pericarditis can develop shortly after a heart attack, due to the irritation of the underlying damaged heart muscle. A delayed form of pericarditis may also occur within some weeks after a heart surgery or heart attack. This condition is known as Dressler’s syndrome. Dressler’s syndrome is also called postpericardiotomy syndrome (PPS), post-cardiac injury syndrome, and post-myocardial infarction syndrome.

Other causes of pericarditis are as follows:

• Systemic inflammatory disorders that include lupus and rheumatoid arthritis
• Trauma, includingheart or chest injury as a result of an accident
• Other health disorders like AIDS, kidney failure, tuberculosis, and cancer
• Use of certain medications, although rare.

Symptoms

Pericarditis can be classified into different types, depending on the pattern of symptoms and how long those last.

• Acute pericarditis generally lasts less than three weeks
• Incessantpericarditis lasts about four to six weeks but less than three months and is continuous
• Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with a symptom-free interval in between
• Chronic pericarditis lasts more than three months

Depending on its type, symptoms of pericarditis may include the following:

• Sharp, piercing chest pain at the center or left side of the chest, which usually intensifies when inhaling
• Shortness of breath, especially when reclining
• Low-grade fever
• Heart palpitation
• An overall sense of tiredness or weakness
• Cough
• Leg or abdominal swelling

If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or on the left side of your chest. However, some individuals with the condition describe the pain as a dull, achy, or pressure-like ache with varying intensity.The pain of acute pericarditis may also be felt in your neck and/or left shoulder. It often intensifies when you cough, lie down, or inhale deeply. Leaning forward or sitting up can ease the pain.

Chronic pericarditis is generally associated with chronic inflammation and may result in the deposition of fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.

Complications

Complications of pericarditis may include the following:

Constrictive pericarditis: Although not very common, some individuals with pericarditis, particularly those with chronic recurrences and long-term inflammation, may develop scarring, permanent thickening, and pericardium contraction.

In such cases, the pericardium may lose much of its elasticity and become tight around the heart, which prevents the heart from functioning optimally. This condition is known as constrictive pericarditis and often leads to severe abdominal and leg swelling, as well as shortness of breath.

Cardiac tamponade: Too much fluid getting collected in the pericardium can lead to the development of cardiac tamponade.Excess fluid exerts pressure on the heart and does not allow it to fill properly, indicating less blood leaves the heart. This results in a significant fall in blood pressure. Cardiac tamponade can be fatal if it left untreated.

diagnosis and prompt treatment of pericarditis can reduce the risk of long-term complications.

Diagnosis

As part of your initial evaluation, your doctor will ask for your medical history and perform a physical exam and check your heart sounds. Sounds in the pericarditis occur when the pericardial layers rub against one another. This noise is known as a pericardial rub.

Your doctor may have you undergo examinations to determine one or all of the following:

• If you suffered a heart attack
• If fluid has collected in the pericardial sac
• If there are signs of inflammation
• If a bacterial or any other kind of infectionare present

You may also undergo one or more of the following diagnostic procedures:

• Electrocardiogram (ECG) to measure electrical impulses given off by your heart
• Chest X-ray to see signs of an enlarged heart or if excess fluid has accumulated in the pericardium
• Echocardiogram to create an image of your heart and its structures, including fluid accumulation in the pericardium
• Computerized tomography (CT) for more-detailed images of your heart and the pericardium than what conventional x-rays reveal
• Cardiac magnetic resonance imaging (MRI) to create cross-sectional images of your heart to reveal thickening, inflammation, as well as other changes in the pericardium

Treatment

Treatment for pericarditis depends on both the cause and severity. Mild cases may get better without any treatment.

Medications

The following medications are often prescribed to reduce inflammation and swelling associated with pericarditis:

Pain relievers: Most pain associated with pericarditis responds well to treatment with pain relievers available without a prescription. These also help lessen the inflammation.

Colchicine: This drug reduces inflammation in the body and can be prescribed for acute pericarditis or to treat recurrent symptoms. However, it is not safe for people with pre-existing health conditions, such as kidney or liver diseases. Consult your doctor to know more about the drug.

Corticosteroids. If you don’t respond well to colchicine or pain relievers or if symptoms of pericarditis keep recurring, your doctor may prescribe a steroid like prednisone.

If a bacterial infection causes pericarditis, you are likely to be prescribed antibiotics.

When to see a doctor

Seek immediate medical attention if you develop new symptoms of chest pain.

Symptoms of pericarditis often are similar to those of other lung or heart conditions. The sooner you get evaluated, the higher are the chances of receiving comprehensive treatment. For instance, although the cause of acute chest pain may be pericarditis, the original cause may be blood clots in your lungs or a heart attack.