Pericarditis is a condition in which the thin membrane surrounding the heart (periccardium) is inflamed, resulting in a swollen and irritated pericardium. This is the result of an infection, a condition or another factor. The patient experiences chest pain due to the rubbing of the irritated layers of the pericardium against each other. Fever, breathing problems, fatigue and swelling of the legs are some other possible symptoms. Usually these symptoms are quite mild and the patient recovers spontaneously, but medication and sometimes surgery are possible treatment methods. When pericarditis is severe or left untreated, potentially life-threatening complications occur.
- Epidemiology condition
- Causes of pericarditis: Infection or condition
- Symptoms: Stabbing chest pain
- Diagnosis and examinations
- Treatment via medication or surgery
- Prognosis of inflammation of the membrane surrounding the heart
- Complications of inflamed pericardium
Pericarditis mainly affects men. The patient is usually between twenty and fifty years old on average. Approximately 5% of all patients admitted to emergency rooms with severe chest pain are diagnosed with pericarditis.
Causes of pericarditis: Infection or condition
The cause of pericarditis is unknown in many patients, although it is often the result of an infection, disease or other causes.
Various infections can lead to pericarditis:
- bacterial infections (less common)
- some fungal infections (rare)
- viral infections that cause a chest cold or pneumonia
The condition is sometimes accompanied by diseases such as:
- autoimmune conditions such as rheumatoid arthritis (inflammation of joints and organs) and lupus, in which the immune system attacks healthy tissues
- an HIV infection and AIDS
- an underactive thyroid gland (hypothyroidism)
- cancer (including leukemia)
- kidney failure
- rheumatic fever (complication of streptococcal infection with symptoms affecting joints, heart, brain and skin)
- tuberculosis (TB) (bacterial infection with lung problems)
Other causes include:
- a heart attack
- a heart operation
- swelling or inflammation of the heart muscle (myocarditis)
- cardiac surgery or trauma to the chest, esophagus or heart
- the use of certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, certain cytostatics (the doctor uses them in chemotherapy against cancer) and certain immunosuppressants (suppress the immune system)
- radiotherapy, especially for breast cancer or lung cancer
Stabbing chest pain occurs with pericarditis / Source: Pexels, Pixabay
Symptoms: Stabbing chest pain
The relatively mild symptoms of pericarditis usually develop suddenly and disappear within a few weeks (acute course). Occasionally the patient gradually develops or persists in symptoms, resulting in chronic pericarditis. The patient has stabbing, sharp, or piercing pain in the left side of the chest or behind the breastbone that extends to the neck, shoulder, back, or abdomen. Some patients experience the pain as dull or oppressive. This pain increases with deep breathing, lying flat, coughing and swallowing. The pain is similar to that associated with a heart attack. The symptoms diminish when the patient sits down and leans or leans forward. In case of infection, chest pain is accompanied by (mild) fever, chills or sweating. Other symptoms include breathing pain and difficulty breathing when lying down, anxiety, a dry cough, palpitations, fatigue, weakness and swelling of the ankles and feet and swelling of the legs.
Diagnosis and examinations
The doctor listens to the heart sounds of the patient with pericarditis with his stethoscope. This examination, known as auscultation, reveals a specific sound, namely the pericardial rubbing. With severe symptoms, the patient may hear cracking lung sounds (rattles), decreased breath sounds, and other symptoms of fluid in the space between the lungs.Electrocardiography (ECG) / Source: CardioNetworks, Wikimedia Commons (CC BY-SA-3.0)Diagnostic examination The cause of pericarditis is often difficult to determine. The doctor conducts the following examinations to identify pericarditis
- A CT scan of the heart
- An echocardiography (examination of the heart using sound waves)
- An electrocardiography (examination of the electrical muscle activity of the heart)
- An MRI scan of the chest and heart
- A radionuclide scanning
- A chest x-ray (x-ray of the chest)
A blood test is also required.
The range of symptoms of the following conditions may mimic pericarditis:
- acute gastritis (acute inflammation of the stomach lining)
- angina pectoris (chest pain, sign of a heart attack)
- aortic stenosis (narrowing of the aortic valve in the heart)
- coronary vasospasm
- an aortic dissection (tear in the wall of the aorta with chest pain)
- a pulmonary embolism (blockage of an artery in the lungs)
- a stomach ulcer
- a myocardial infarction (death of a piece of the heart muscle)
- an esophageal rupture
- myocardial ischemia (oxygen deficiency of the heart muscle)
- esophageal spasm (esophageal spasms)
- esophagitis (an inflammation of the esophagus)
Treatment via medication or surgery
It is important for treatment that the doctor identifies the cause. The patient reduces symptoms by taking high doses of nonsteroidal anti-inflammatory drugs (NSAIDs). Antibiotics combat bacterial infections, antifungal medications (antifungals) combat pericarditis resulting from a fungal infection. In some patients, corticosteroids, powerful anti-inflammatory drugs, are helpful. Diuretics (water pills) also remove excess fluid.Sometimes a pericardiocentesis is necessary to drain fluid from the pericardium, which is possible with a guided needle in combination with echocardiography. The surgeon may also make a small hole in the pericardium so that the contaminated fluid ends up in the abdominal cavity. When treatment is ineffective, surgery is required via pericardiectomy. The doctor removes part of the pericardium.
Prognosis of inflammation of the membrane surrounding the heart
In most patients, pericarditis is a mild disease from which the patient recovers spontaneously. But other patients experience life-threatening symptoms. The fluid buildup around the heart and poor heart function sometimes cause complications. The results are often good when the patient receives quick and effective treatment. The recovery process then takes an average of two weeks to three months. Pericarditis is a condition that may recur.
Complications of inflamed pericardium
Scarring and thickening of the pericardium occur in a serious condition (constrictive pericarditis). In addition, cardiac tamponade may occur. This causes compression of the heart because the pericardium fills with blood as a result of an injury, a rupture, after heart surgery. This causes the blood pressure to drop dramatically, which is potentially fatal. Cardiac tamponade causes palpitations, nausea, light-headedness and blurred vision. Cardiac tamponade is often accompanied by inflammation of the heart muscle (myocarditis). The pressure on the chest during cardiac tamponade is comparable to the pain of a heart attack.
- Acute pericarditis: Types of inflammation of the pericardium
- Constrictive pericarditis: Type of inflammation of the pericardium
- Myocarditis: Inflammation of the heart muscle
- Endocarditis: Inflammation of the lining of the heart
- Heart disease alarm symptoms: Signs of heart disease