Pericarditis is a human heart disorder in which the lining of the heart becomes inflamed. This lining is called the pericardium. The pericardium performs many important roles that aid to the normal functioning of the heart. It holds the human heart in its appropriate position in the chest; it protects the heart from infection by separating it from the other internal organs and prevents the heart from overfilling with blood. It also lubricates the heart with the pericardial fluid to reduce the friction produced because of the contraction and relaxation of the heart muscles.
What are the Types of Pericarditis?
Pericarditis can be either acute or chronic in nature. Acute pericarditis develops suddenly and is typically resolved within three weeks with rest and therapy. The patients typically complain of a sharp pain the chest that resembles the pain experienced during a heart attack. This pain is pronounced when the patient inhales and improves when the patient leans forward while sitting up. The patients also experience low blood pressure, a high temperature (fever), and heart palpitations. In Chronic pericarditis, the symptoms develop gradually over a period of many months. It also takes longer to treat the condition and more often than not, the patient develops further complications.
What Causes Pericarditis?
A whole host of reasons could cause pericarditis. This includes many forms of infection, metabolic disorders, neoplasia, autoimmune diseases, tuberculosis, renal failure and many others. In a majority of the cases, it is difficult to identify a specific cause and the treatment is usually directed to improve the symptoms of the condition. Now whatever the cause, once the condition is developed, it tends to follow a similar clinical reaction independent of the cause.
Is Pericarditis Recurrent?
In vast majority of the patients with acute pericarditis, symptoms return within a few weeks of discontinuing treatment. In some patients, this manifests as a single recurrence while others experience this repeatedly over a period of few years. The predominant symptom experienced during an episode of recurrence is chest pain. This may or may not be accompanied by other clinical symptoms experienced during the initial attack.
What Causes the Recurrence of pericarditis?
Recurrence of acute pericarditis is a serious complication. Most patients with recurrent pericarditis have a history of allergy such as urticaria, asthma or hay fever. The patients have also been known to have a higher level of ESR (erythrocyte sedimentation rate) during the attack that is typically seen during a hypersensitivity reaction. Hence, the hypothesis is that hypersensitivity is a contributing factor to the development of recurrence.
Apart from the predisposition to allergy, the pericarditis is also more frequently seen in the patients who are suffering from other autoimmune disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. These patients also have a higher incidence of developing a recurrent bout of pericarditis.
In cases where the original cause of acute pericarditis was some kind of infection than re-infection will often result in recurrence of this condition.
Another cause of recurrence could be insufficient dose or duration of therapy. If the patient was treated with corticosteroids and the dose was either, too low to be effective or the dose was not tapered slowly enough before discontinuing therapy, then the chances of recurrences increase. So though corticosteroids remain a popular choice among physicians, it would be preferable to start of treatment with other over the counter non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen, which are equally effective at reducing pain and inflammation. If this first line of treatment is not effective, it is recommended to use colchicine as a second line treatment as it is associated with a lower rate of recurrence when compared to other corticosteroid therapy.
Recurrent pericarditis continues to be a vexing problem to physicians. Successful management depends on correctly identifying the cause of the condition and treating the patient with treatment dose and duration.
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