The pericardium is a double-layer, sac-like membrane that covers the heart and protects it from neighboring structures. Between both layers there is a small amount of liquid that acts as a lubricant favoring that they can slide on each other.
When pericardium is inflamed, pericarditis originates. In these circumstances, the level of liquid increases and can clog the heart, and prevent it from function correctly. This condition affects mainly men between 20 and 50 years old.
In most cases, the cause is unknown. Nevertheless, this pathology is a consequence of a viral or bacterial infection, or may be associated to the following:
- Systemic diseases such as cancer, renal insufficiency, leukemia, HIV, rheumatoid arthritis or systemic lupus erythematosus.
- Cardiovascular diseases: Myocardial infarction and myocarditis
- Chest injuries, lesions in the esophagus or heart.
- Certain treatments, such as radiation therapy, and certain drugs, such as anticoagulants, procainamide, penicillin, phenytoin, and phenylbutazone.
In acute pericarditis, which lasts less than 6 weeks, the patient presents pain in the precordial region (anterior and central area of the chest), which can be intense and oppressive and, sometimes, it radiates to the back, neck and left shoulder and arm.
The pain gets worse with deep inspiration, lateral movements of the chest and when the patient lies on his back. Some patients experience constant pain in the sternum similar to the agony produced by acute myocardial infarction, in which case fever and tachycardia may occur.
Chronic pericarditis, on the other hand, lasts more than 6 weeks; it is accompanied by dyspnea, cough (due to the expulsion of fluid into the alveoli –which are tiny air sacs in the lung- that causes the high pressure of the veins) and fatigue due to the poor functioning of the heart. It is also common the deposit of liquid in the abdomen and legs, but the condition itself is practically painless.
Acute pericarditis can be detected, in addition to the description of pain, from cardiac auscultation. A chest x-ray and an echocardiogram may reveal the presence of fluid in the pericardium. Blood tests, on the other hand, allow detecting some of the causes, among them, leukemia or HIV.
A chest x-ray also allows observing if there are calcium deposits in the pericardium, although it may not be conclusive. A catheterization or a magnetic resonance image helps to confirm the diagnosis and the increase in the size of the pericardium.
Can Pericarditis Become Life Threatening?
In most cases, mainly those originated by viruses, pericarditis is a self-limited event, which responds well to anti-inflammatory and heals after 1 to 3 weeks. However, pericarditis can develop life-threatening complications. The two main complications of pericarditis are: cardiac tamponade and constrictive pericarditis.
Cardiac Tamponade: In some cases of pericarditis there may be fluid accumulation between the layers of the pericardium. In about 5% of cases this build up is so great that excess fluid compresses the heart chambers, preventing the heart from filling and pumping blood properly. Cardiac tamponade is a medical emergency because the patient can go into shock because of a heart pump failure.
Constrictive Pericarditis: Although infrequent, some people with pericarditis, with a long inflammation and with frequent recurrences, may develop permanent scarring and a thickening of the pericardium. In these patients, the pericardium loses its elasticity, becomes rigid and compresses the heart, making it difficult to pump blood. Constrictive pericarditis usually causes tiredness, difficulty breathing and edema of the legs and abdomen.
The treatment depends on how the pericarditis occurs, as well as the cause that originated it. In general terms, patients must be hospitalized and given anti-inflammatory drugs. When the pain is very intense, doctors recommend the administration of opioids or corticosteroids.
Evolution and prognosis of the disease are very variable. In fact, in some cases, even when the disease is in a mild stage it can evolve into a life-threatening condition. Besides, prognosis will get worse if there is a buildup of liquid around the heart or when the heart muscle does not work properly.