Pericarditis is the inflammation of the sac like lining, pericardium, surrounding the heart. The function of pericardium is to hold the heart in place when body is in motion or when at rest.
The etiology of pericarditis is mainly idiopathic, other causes include viral, bacterial or fungal. It can also be found in heart diseases, heart attacks, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, ankylosing spondylitis, IBS, kidney failure, trauma to chest, leukaemia, and radiation therapy and also due to some medications. Pericarditis can be both acute and chronic. Acute pericarditis is which occurs suddenly and does not last long, resolves within 2-6 weeks. Chronic pericarditis develops over time and it takes longer to resolve and symptoms last over 3 months. Chronic pericarditis can also be recurrent, means that it recurs after being treated.
Symptoms of pericarditis
The classic symptom of pericarditis is sharp chest pain, on rare occasions it can also be dull in nature. The pain usually originates in the middle of the chest and might radiate to the neck, upper back and shoulders. The chest pain worsens on lying down, breathing deeply, coughing and swallowing. It is relieved on sitting upright. Pericarditis also may present with fever, chills, shortness of breath, fatigue, weakness. If one has chest pain symptoms along with one or other symptoms, one must call emergency help without any delay. The medical practioner will examine the patient clinically and will further diagnose with the help of auscultation of the heart, chest x-ray, electrocardiogram, and echocardiogram and on occasions, CT heart and heart ultrasound.
Treating pericarditis
Pericarditis is treated mostly for chest pain and inflammatory symptoms. Treatment mainly includes analgesics and anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs, including ibuprofen, aspirin, indomethacin, and naproxen. On occasions, colchicine or steroid treatment may also be indicated. Severe cases of pericarditis may require pericardiocentesis or pericardiectomy.
What Can Make Pericarditis Worse?
Pericarditis, like any other disease needs proper treatment and completion of the treatment course. With proper treatment, symptoms of pericarditis will gradually improve, but if the whole course of treatment is not completed, the symptoms might recur. Some patients, after the initial course of medications, do not complete the whole course of treatment after they start improving initially, but this should be avoided. Pericarditis might relapse and recur.
Pericarditis is also worsened if the patient does not follow the complete instructions of the doctor while recuperating. Patients are advised to rest and avoid all exertional activities such as exercise. Physical activity is prohibited in patients with pericarditis and complete rest is advised. Patients do not pay any heed to the instructions and start exercising and exhausting their body and this in turn worsens pericarditis and the inflammatory process starts again.
The symptoms of pericarditis may also worsen because of stress. Stress is the contributory factor in 80-90% of modern diseases and pericarditis is no exception. Anxiety exaggerates the symptoms of pericarditis and the patient might present with extreme chest pain, irregular heart rhythm, hypotension/hypertension, fatigue, extreme sweating. This might require additional and alternative treatment. To improve stress and anxiety the patient needs to rest and also cognitive behavioral therapy might be needed.
There are certain complications of pericarditis such as cardiac tamponade; results in accumulation of large amounts of fluid which might cause diastolic heart failure. It is treated with pericardiocentesis (drainage of fluid from the pericardium). The other complication is constrictive pericarditis; it is thickening of the pericardium that inhibits the proper function of the heart. It is treated with pericardiectomy (excising the thickened part of the pericardium).
There also might be complication when trying to taper off medications and this is known as relapsing or recurrent pericarditis. It can be classified into incessant and intermittent pericarditis. Incessant pericarditis occurs when trying to wean off medication in less than 6 weeks. It is frequently seen in patients treated with steroids, but can be seen in patients treated with anti-inflammatory drugs too. Intermittent pericarditis refers to those cases that have symptom free interval longer than six weeks without any treatment. These are managed again with rest and colchicine treatment.
Rest is the mainstay to treating pericarditis including other therapeutic treatments.
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