Pericarditis is a heart disorder in which the lining of the heart becomes inflamed. This lining is called the pericardium.
What is the Role of the Pericardium?
The pericardium consists of two main layers: the outer tough layer called the fibrous pericardium and the internal thin layer called the serous pericardium. The fibrous pericardium holds the heart in place and separates it from the adjacent internal organs. This layer is less flexible and does not stretch much so it is helpful to prevent overfilling of the heart with blood. The serous pericardium further consists of two layers between which is the pericardial cavity that contains a small quantity of fluid called the pericardial fluid. This helps to lubricate the heart and prevents the friction caused heart movement within the thoracic cavity.
What are the Clinical Symptoms Of Pericarditis?
As described above, the pericardium has many important physiological functions that aid in the smooth running of the heart. Pericarditis leads to malfunction in performing these functions. The swelling of the pericardium causes the tissues in the heart to rub against each other and increases the internal friction. This affects the speed with which the heart contracts and relaxes. Prolonged irritation to the tissues causes excess fluid to collect in the pericardial cavity. This increases the pressure on the heart walls and in turn affects the capacity of the blood the human heart can pump.
The most common clinical symptom experienced by patients is sudden chest pain that resembles a heart attack. The patients also experience low blood pressure, a high temperature (fever) and heart palpitations.
What Medicines Are Used To Treat Pericarditis?
Pericarditis usually goes away on its own with proper rest and care. Recovery may take a few days to weeks or even months. Patients are usually treated with medicines that will reduce their pain and inflammation.
Pain Relievers: Most patients respond well to over-the-counter nonsteroidal anti-inflammatory drugs such as indomethacin, naproxen, aspirin, ketorolac or ibuprofen that relive both the inflammation and pain associated with the condition and allow the patient to recover. Prescription pain relievers may be required in some cases. Patients are advised to rest for at least a week or more during treatment.
For patients with a recent history of a heart attack, it is recommended to substitute ibuprofen with high dosage of aspirin. NSAIDs are also prone to produce gastrointestinal toxicity in few patients.
Colchicine: This drug may be prescribed to patients with acute pericarditis as it has an anti-inflammatory effect. This drug reduces the time course of the clinical symptoms. It also decreases the risk of a recurrence. Although well tolerated, colchicine is not approved for the prevention of recurrent pericarditis in the United States & Europe. However, it is not safe for use in special populations such as patients with pre-existing liver or kidney disease or those taking certain prescription medication.
Corticosteroids: Corticosteroids slows the pericardial inflammation by stopping several immunological pathways. Patients may need treatment with prescription steroids such as prednisone if they have refractory symptoms. These would be scenarios where the patient did not respond favorable to pain relievers or colchicine. One of the reasons we do not start treatment with steroids is because they are associated with an increased incidence of recurrent pericarditis. They can also generate ill effects like weight gain and mood swings when used over a prolonged period.
Antibiotics: In those cases where the pericarditis was a result of an underlying bacterial infection, the patients will be treated with antibiotics. The patients may also need to be drained of excess fluid if necessary.
When to Consider Hospitalization And Surgery?
If the patient develops any serious complication because of chronic pericarditis such as cardiac tamponade or constrictive pericarditis, the doctor may recommend hospitalization. Treatment may include a surgical procedure to remove the excess fluid in the pericardial cavity or removal of the entire pericardium.