Pericarditis

Pericarditis: Types, Symptoms, Causes, and Diagnosis

Pericarditis: Types, Symptoms and Diagnosis

Introduction

Pericarditis is an irritation and swelling in the pericardium, a sac-like, thin tissue that surrounds the heart’s outer surface. The pericardium protects the heart and vessels and keeps the heart inside the chest wall. Pericarditis develops suddenly and may last from weeks to some months. Chest pain and breathing difficulty are the two prominent symptoms of pericarditis. Early diagnosis may reduce the greater risk of complications in pericarditis patients. 

Types:

Pericarditis has different types according to the symptoms and their severity, which may include:

  • Acute pericarditis: It is the most common painful condition of pericardium inflammation. This inflammation develops suddenly and lasts more than three weeks. Its causes include bacterial, fungal, and viral infections; other causes are chest injury, rheumatoid arthritis, kidney failure, lung cancer, and rheumatic fever. Acute pericarditis patients feel fever and sharp pain in the left side or middle of the chest.  
  • Chronic pericarditis is the long-lasting inflammation in the pericardium that lasts more than three months. It begins gradually and results in fluid accumulation in the pericardial space. The symptoms of chronic pericarditis may include fatigue, cough, and breathing difficulty. Echocardiography is often used for its diagnosis. 
  • Constrictive pericarditis is an infrequent condition in which the pericardium layer becomes stiffer and thicker and develops scar tissue. Therefore, the heart muscles cannot expand. Constrictive pericarditis interferes with the normal functioning of the heart. During this condition, the heart becomes compressed and struggles to pump the blood to the rest of the body; this pressure can lead to heart failure. It developed slowly and lasted more than three months. Furthermore, its symptoms may include chest pain, dizziness, water retention, swelling in the lower legs and abdomen, breathing difficulty, and fatigue. 
  • Uremic pericarditis: It mainly occurs in patients with chronic kidney disease. The symptoms of constrictive pericarditis are breathing difficulty or swelling in the legs or feet. 
  • Infectious pericarditis: It is the irritation of pericardium that develops after bacterial, viral, parasitic, or fungal infection. 
  • Delayed pericarditis is the inflammation of the pericardium referred to as Dressier syndrome. It develops within weeks after a heart attack or heart surgery. The symptoms of delayed pericarditis are fatigue, fever, loss of appetite, and chest pain after coughing and deep breaths.
  • Incessant pericarditis is an inflammation with persistent symptoms that lasts not more than three months. 
  • Traumatic pericarditis develops after a chest injury, such as a car accident. 
  • Malignant pericarditis: It develops after cancer grows in the body.  

Causes: 

These are the different causes of pericarditis, which include:

  • Viral infections: These are the common causes of pericarditis. For example, gastrointestinal viruses may cause viral pericarditis. 
  • Fungal infections may cause fungal pericarditis, such as Candida albicans. 
  • Bacterial infections: Bacterial infections cause bacterial pericarditis like tuberculosis. 
  • Autoimmune diseases: Autoimmune disorders may cause pericarditis. For example, rheumatoid arthritis, lupus, and scleroderma.
  • Chest injury: Chest injury, like car accidents, cause traumatic pericarditis. 
  •  Tumors: Tumors can cause malignant pericarditis. 
  • Kidney failure: Uremic pericarditis may cause by kidney failure.
  • Parasitic infections: They cause parasitic pericarditis such as Schistosomiasis.
  • Medications: Certain medications like procainamide and phenytoin.  
  • Covid-19 infection
  • Heart injury

Symptoms:

There are various symptoms of pericarditis, such as:

  • Severe chest pain during swallowing, coughing, and deep breathing
  • Pain in the left shoulder or neck
  • Dry cough
  • Heart palpitations
  • Fever
  • Fatigue
  • Swelling in the legs and feet 
  • Breathing difficulty
  • Anxiety

Diagnosis: 

 Visit the doctor immediately if you feel chest pain and difficulty breathing. The doctor will ask you about your medical history and review the health problems and surgery that may put you at risk of this disease. Moreover, the specialist may recommend different diagnostic tests to check the severity of pericarditis, which may include:

    • Chest X-Ray: This imaging test uses X-rays to estimate the heart’s size and fluid in the lungs. 
  • Echocardiogram: A process in which the sound waves are used to see heart conditions. The doctor checks the functioning of the heart and the fluid surrounding the heart. These sound waves show the symptoms of constrictive pericarditis, having a stiff pericardium that constricts the normal movement of the heart. 
  • Electrocardiogram (ECG): It checks electrical activity and heart rhythm. The sensors are attached to the chest at different points during this procedure to examine the heart problems. 
  • CT scan: It is used to visualize the heart problems, inflammation, tumors, fluid, and calcium inside the pericardium. In this test, iodine is used to get detailed information about inflammation. This test is crucial for constrictive pericarditis patients. 
  • Cardiac MRI: In this test, radio waves and a magnetic field are used to get detailed heart images. It checks pericardial inflammation, extra fluid in the pericardium, and heart compression. 
  • Cardiac catheterization: It is used for the treatment of constrictive pericarditis. 
  • Blood tests: Blood tests are done to evaluate the leading cause of pericarditis by checking the functioning of the heart. 

Treatment:

Generally, it is a mild pain and can be cured without medications. Doctors can suggest medicines like ibuprofen or aspirin for inflammation and pain or prescribe antifungals or antibiotics for infection. Furthermore, recommended vaccinations and good hygiene can help to prevent pericarditis. The more severe conditions require other treatments, which may include:

  • Oral or intravenous steroids such as prednisolone
  • Diuretics help to remove the excess fluid from the body
  • Anti-inflammatory medications
  • Pericardiectomy to remove the pericardium
  • Pericardiocentesis 

Risk factors:

The common risk factors of pericarditis are:

  • Heart attack
  • Radiation therapy
  • Autoimmune diseases
  • Percutaneous treatment, for example, radiofrequency ablation or cardiac catheterization. 

Complications: 

These are the potential complications of pericarditis are as follow:

    • Pericardial effusion: It is the buildup of fluid in the pericardium. It causes chest pain, breathing difficulty, lightheadedness, and other heart complications. If the pericardial effusion is left untreated, it may cause heart failure.
    • Constrictive pericarditis: Constrictive pericarditis may cause permanent scarring and thickening of the pericardium. These changes may cause swelling in the abdomen and legs and breathing difficulty. 
  • Cardiac tamponade is a severe condition that occurs when the space surrounding the heart fills with fluid or blood and creates pressure on the heart. Due to this pressure, the patient’s heart doesn’t beat properly; it requires immediate treatment. Common cardiac tamponade symptoms are chest pain, dizziness, jaundice, fatigue, and heart palpitations. 

References:

https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc-20352510#

https://my.clevelandclinic.org/health/diseases/17353-pericarditis  

https://www.healthline.com/health/pericarditis 

https://www.heart.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis#

https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/pericardial-disease-and-myocarditis/chronic-pericarditis# 

https://www.healthline.com/health/dressler-syndrome 

https://my.clevelandclinic.org/health/diseases/22373-constrictive-pericarditis# 

https://www.aurorahealthcare.org/services/heart-vascular/conditions/pericarditis 

https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/symptoms-causes/syc-20353720#

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