The heart is surrounded by a protective thin avascular sac known as the pericardium, which contains an insignificant amount of fluids. Any inflammation to the pericardium is called as “Pericarditis.” Pericarditis syndrome may be acute, subacute, chronic or recurrent form. Acute form is the most frequent inflammatory syndrome encountered in clinical practice, usually lasting not more than 6 weeks. Chronic form is the long-lasting inflammatory syndrome (> 6 months) which is characterized by more accumulation of fluid and thickening of the pericardial sac. It is uncommon, generally preceded by acute pericarditis form. Patient show shortness of breath accompanied with a cough, tiredness, sharp chest pain, and pain possibly will occur in the shoulders, neck, or hands. Cough and abnormal breath occur due to the high pressure in the blood vessels of the lungs and tiredness occur because the pericardium restricts the normal heart’s pumping action.
What Can Cause Chronic Pericarditis?
Chronic Pericarditis may be caused by many factors. Several cases are idiopathic i.e. no identifiable causes found after routine testing but many known factors cause pericarditis, such as viral, bacterial, or fungal pathogens. Nearly, 80% of the cases are caused by viral infection in the developed country. Viruses include coxsackievirus, echovirus, and adenovirus; but in the third world countries HIV, tuberculous pericarditis, histoplasmosis, Aspergillus, Candida, and Coccidioides are the most common cause of pericarditis. Rest 20% is caused by certain disease like autoimmune disease (systemic lupus erythematosus and rheumatic fever), Myocardial infarction, Trauma to the heart, Uremia (uremic pericarditis) and Cancer sometimes, a very rare phenomenon also responsible for this condition which includes medicines (isoniazid, cyclosporine, hydralazine, and anticoagulants) and radiations.
Type of Chronic Pericarditis
Chronic effusive pericarditis and chronic constrictive pericarditis are the two key types of chronic pericarditis.
In chronic effusive pericarditis, the fluid between the two layers (serosal and fibrous) starts slowly accumulates and become excess amount in the pericardial space. In normal condition, the fluid usually accounts 30 to 50 ml, which supports the heart to locomote freely within the pericardial sac. Most of the cases are idiopathic whereas known factor include TB, breast and lung cancer, hypothyroidism, high blood pressure, coronary artery disease, cardiomyopathy, heart valve disorder, and bradycardia. A biopsy from the patients can able to determine the cause of chronic pericarditis—for example, tuberculosis. The patient’s exhibit discomfort in breathing, pain behind the breastbone, and sometimes they feel heaviness and chest fullness.
Chronic constrictive pericarditis is an exceptional condition, generally its effects in scar like fibrous tissue forms throughout the pericardium. The fibrous tissue tends to contract over the years, compressing the heart. The tissue compress inhibits the heart to perform its normal function, thus leading to heart failure, swollen abdomen, difficulty breathing (dyspnea), swelling of legs and general weakness. Sometimes the inflammation occurs without symptoms. The main reason for this condition includes viral, TB bacterial pericarditis, post-surgical (including cardiac catheterization), hereditary, chemical trauma, and connective tissue disorders.
Chronic constrictive pericarditis can be cured by surgery but several risks are associated and may result in death. Death due to surgery accounts 5 to 15% of patients whose condition is severe form.
Diagnosis, Treatment, and Management
Echocardiography can able to detect the excess fluid and scar like tissue formation surrounding the heart. It also helps in diagnosing cardiac tamponade, also called as pericardial tamponade, a chronic effusive pericarditis condition when fluid forms up in excess and results in compression of the heart. Sometimes, a chest x-ray is supportive which can able to detect calcium accumulation in the pericardium. Cardiac catheterization, Magnetic resonance imaging or computed tomography can be used to determine the pericardium.
Removal of fluid by needle drainage or surgical drainage can help the patients to relieve symptoms. Salt restriction and diuretics drugs also relieve symptoms especially in chronic constrictive pericarditis.
Recurrent pericarditis is the most disturbing complication of pericarditis occurring within a year in 30% of patients after the first incident of acute pericarditis. It may lead to cardiac tamponade or chronic constrictive pericarditis in some patients.