Pericarditis is the inflammation of pericardium, the two layers of a sac-like tissue surrounding the heart. The function of pericardium is to keep the heart in position when we are in motion such as walking or running. Generally, a small amount of fluid is present in between the two layers of pericardium to prevent friction. An inflammation usually results in a build-up of this fluid leading to poor heart function.
Types of Pericarditis
Pericarditis can be broadly classified into two types:
Acute pericarditis occurs suddenly and does not last long.
Chronic pericarditis develops over a period and the symptoms persist for more than 3 months or are recurrent.
Symptoms of Pericarditis
Mostly, pericarditis presents as a sharp and stabbing pain that might mimic a heart attack, but on occasions might be dull pain too. The pain begins in the middle of the chest and radiates to the upper back/neck area. The chest pain sometimes worsens on lying down, coughing and swallowing. It is often relieved on sitting up. The pain might also cause painful breathing. Other symptoms include fever, chills, shortness of breath, difficulty swallowing, weakness, fatigue and malaise. Generally, men are at an increased risk of developing pericarditis.
What Are The Causes Of Pericarditis?
The exact cause of pericarditis is unknown. The other common causes include infections such as viral, bacterial, or fungal. It might also present in inflammatory diseases such as rheumatoid arthritis, SLE, ankylosing spondylitis, scleroderma, inflammatory bowels disease, heart diseases such as Dressler’s syndrome, heart attack causing irritation and inflammation of the pericardial lining, trauma to the chest, kidney failure, tumors including leukemia, radiation therapy to the chest and also due to certain medications such as procainamide, hydralazine, phenytoin, isoniazid, and immunosuppressant drugs.
Pericarditis Diagnosis
Pericarditis is usually confirmed with past medical history and physical examination. The history of pain and the character would indicate pericarditis. A history of previous chest infection is important, especially if it is recurrent. The most common physical finding is a pericardial frictional rub. In addition, it might present with signs of fluid in the pericardium, known as pericardial effusion or fluid in the lungs, known as pleural effusion. Heart sounds may also be distant or muffled.
The imaging tests may be done to check the heart and tissue layer, which include X-ray of the chest, electrocardiogram, and echocardiogram, ultrasound of the heart, radionuclide scan or CT scan. Troponin I test will show further heart muscle damage. Other tests may include CBC, blood culture, CRP test, ESR, HIV test, rheumatoid factor and TB skin test.
Can Pericarditis Go Away On Its Own?
Sometimes pericarditis is mild and goes away on its own with just anti-inflammatory drugs or NSAIDs (ibuprofen or naproxen). A short course of narcotic drugs may be used to relieve severe pain. If it is due to bacterial infection antibiotics are used, and antifungals are needed for fungal infection. Other medicines that are used are corticosteroids for e.g. prednisone, diuretics (for removing excess fluid), colchicine to prevent swelling caused by inflammation.
If pericarditis is not treated thinking that it will go away on its own then it might also present with certain complications such as:
Cardiac Tamponade: It is the most dangerous complication that can occur, which results in the accumulation of large amounts of fluid leading to decreased blood pressure and altered heart function. It is treated with pericardiocentesis (fluid drainage from the sac) and pericardiotomy (making a small hole in the pericardium for drainage of infected fluid in the abdominal cavity). It is a medical emergency and the patient may present with shock, hypotension, difficulty breathing, or congestive cardiac failure.
Constrictive Pericarditis: This mostly occurs due to chronic/recurrent pericarditis that causes scarring and thickening of the sac-like covering and the heart muscle. It is treated with pericardiectomy (severing a part of the pericardium).
Therefore, it is advisable to get pericarditis treated without waiting for it to resolve on its own.
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