Pericarditis
What is Pericarditis?
Pericarditis is a condition where the Pericardium, which is a double layered thin sac or membrane which surrounds the heart, becomes inflamed or irritated. This causes a certain type of chest pain. The purpose of the Pericardium is to lubricate and surround the heart, keeping it secure and preventing sudden movements from damaging it. It is a double layered membrane, with fluid between the two layers, which acts as a shock absorber to the heart structure. It also helps to prevent infection or disease from adjacent tissue.
Different types of Pericarditis
Acute Pericarditis
Acute Pericarditis indicates that the condition occurs quickly, and usually does not last long.
Chronic pericarditis
Chronic Pericarditis means that it develops over time and may take longer to treat.
Constrictive Pericarditis
This is a condition where the Pericardium becomes very thick and scarred.
Who is likely to suffer from Pericarditis?
Anyone can potentially suffer from pericarditis, but the condition is most often experienced by young or middle aged men, typically in the 20-50 year old age range.
What causes Pericarditis?
The pain of pericarditis is caused by a constriction of the heart muscle. This is due to an increase in the amount of fluid which is contained between the inner and outer membrane of the Pericardium. The constriction can exert extra pressure on the heart by rubbing against the heart, and can cause pain in the chest or even prevent the normal functioning of the heart. The most common cause of Pericarditis is an infection, especially in young people (usually viral, for example coxsackie or mumps), although evidence has shown that in approximately 50% of all cases the cause is unknown. However there are also some other less common causes which may include the following :-
- Heart Attack (Myocardial Infarction)
- Heart surgery
- Tuberculosis (TB)
- HIV or AIDS virus
- Cancer or radiotherapy
- Leukaemia
- Rheumatoid Arthritis
- Kidney related problems
- Drug treatment side effects
- Infection from Bacteria or fungus
- Physical injury such as chest compression, or knife wound
- Lupus
- Scleroderma
Symptoms of Pericarditis – How is Pericarditis diagnosed?
There are certain types of chest pain which give clues as to their type and origin. Pericarditis has some unique ‘signature’ symptoms. The main symptom is that of chest pain related to movement, in the middle, but possibly on the left part of the chest. The pain may be sharp in nature or like a stabbing pain, but could also be continuous and steady pain. However it is commonly related to a range of motion related triggers including :-
- Deep breathing
- Coughing
- Pain when lying down or leaning forwards
- Anxiety or a feeling of ‘expectancy’
- moving from the stationary position
Sometimes Pericarditis pain may also manifest itself in the neck and shoulder, although other less common symptoms of Pericarditis include swelling of the ankles, feet and legs. When you go to the doctor with chest pain, he or she will usually investigate your medical history, and examine you physically, and listen to your vital signs with a stethoscope. The sound that the doctor hears through the stethoscope can pinpoint Pericarditis as the source of the pain because it may sound like a grating, scratchy noise (this is called the pericardial friction rub), or your heartbeat may sound ‘scratchy’, distant and muffled. Additional diagnostic tests may possibly be used to confirm the diagnosis including :-
- X-Ray or Electrocardiogram (ECG) to confirm the presence of excessive fluid in the Pericardium
- Blood test (to check for bacterial infection)
- Chest / Heart MRI scan
- Radionuclide scanning (where the patient ingests a radioactive substance so the doctor can detect abnormal areas by looking at the amount of radioactivity in the organs)
Is Pericarditis Serious?
Fortunately most cases of Pericarditis are not life threatening or serious, and recovery is usually possible after a few weeks, or possibly a few months for more severe cases, with prompt and appropriate medical care. However, the pain associated with Pericarditis can be similar to that of a heart attack or a collapsed lung, so it is very important that all sources of chest pain are urgently investigated by a physician or heart specialist.
Treatment for Pericarditis
If the initial diagnosis indicates that Pericarditis may be the most likely cause of your pain you may initially be prescribed common anti-inflammatory drugs (NSAID’s). for more severe or prolonged cases, further treatment may be required which may involve specialist drug medication or surgery as:-
Steroid Treatment
In some cases where pericarditis is severe or keeps coming back, a Steroid drug such as Prednisone may be prescribed.
Immunosuppressant Treatment
Azathioprine, which is an immunosuppressant, can be used in patients who do not respond to steroid treatment.
Surgery to remove excess fluid
Sometimes, if the pain is severe or the heart is being seriously affected, the excess fluid in the pericardium will have to be drained – a procedure known as Pericardiocentisis A Surgical correction known as Pericardiotomy may be necessary, although this is rarely required.
Complications associated with Pericarditis
There are a few rare complications that people who suffer from pericarditis may suffer from. These are:-
Tamponade
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium and increases the pressure on the heart. In extreme cases this can prevent the heart’s chambers (ventricles) from filling properly with blood, and may lead to shock and death.
Abnormal heart rhythms – Arrhythmias
These are caused by abnormal electrical activity in the heart which cause the heart to pump less effectively. Each heart beat originates as an electrical impulse from a small area of tissue in the right atrium of the heart, and so the pressure exerted by a Pericarditis condition can interfere with this signal, and hence the normal function of the heart.