Pericarditis is the inflammation of the pericardium, the thin sac-like membrane surrounding the heart. While often benign, it can sometimes lead to serious complications, making early recognition and proper management essential.
What is Pericarditis?
The pericardium has two layers: the visceral layer (closely attached to the heart) and the parietal layer (outer layer). In pericarditis, inflammation of these layers can lead to chest pain, fluid accumulation (pericardial effusion), and in severe cases, cardiac tamponade.
Causes of Pericarditis
Pericarditis can be caused by a variety of conditions:
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Viral infections: Coxsackievirus, echovirus, influenza
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Bacterial infections: Tuberculosis or pyogenic bacteria (rare)
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Autoimmune diseases: Systemic lupus erythematosus, rheumatoid arthritis
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Post-myocardial infarction: Dressler’s syndrome
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Uremia: In chronic kidney disease
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Trauma or cardiac surgery
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Certain medications: e.g., hydralazine, procainamide
Symptoms of Pericarditis
The hallmark symptom of pericarditis is sharp, pleuritic chest pain that often improves when sitting up and leaning forward. Other symptoms may include:
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Shortness of breath, especially when lying down
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Low-grade fever
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Fatigue
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Palpitations
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Swelling in the legs or abdomen (in severe cases)
Physical Examination Findings
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Pericardial friction rub: A scratching or grating sound heard on auscultation, best at the left lower sternal border
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Tachycardia: Rapid heart rate
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Signs of pericardial effusion or tamponade: hypotension, distended neck veins, muffled heart sounds
Diagnosis of Pericarditis
Key Diagnostic Tests
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Electrocardiogram (ECG):
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Diffuse ST-segment elevation
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PR-segment depression in multiple leads
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Echocardiography:
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Detects pericardial effusion and assesses heart function
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Chest X-ray:
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May show an enlarged cardiac silhouette if effusion is present
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Blood tests:
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Elevated inflammatory markers (ESR, CRP)
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Cardiac enzymes may be slightly elevated
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Treatment of Pericarditis
The treatment approach depends on the cause and severity:
1. Medications
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NSAIDs (e.g., ibuprofen, aspirin): Reduce pain and inflammation
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Colchicine: Reduces recurrence rates
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Corticosteroids: Reserved for refractory or autoimmune-related pericarditis
2. Management of Complications
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Pericardiocentesis: Draining fluid in cases of cardiac tamponade
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Treatment of underlying cause: e.g., antibiotics for bacterial pericarditis, dialysis for uremic pericarditis
3. Lifestyle Measures
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Rest during acute episodes
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Avoid strenuous activity until symptoms resolve
Complications of Pericarditis
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Pericardial effusion: Accumulation of fluid around the heart
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Cardiac tamponade: Life-threatening compression of the heart
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Constrictive pericarditis: Thickened pericardium restricting heart function
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Recurrence: Especially in idiopathic or autoimmune pericarditis
Prevention and Prognosis
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Treat underlying infections promptly
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Manage autoimmune conditions effectively
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Avoid unnecessary trauma to the chest
Most cases of viral or idiopathic pericarditis resolve within 1–3 weeks with proper treatment, though recurrent episodes may occur in some patients.
Conclusion
Pericarditis is an inflammatory heart condition that can range from mild to life-threatening. Early recognition of classic chest pain, friction rub, and ECG changes is critical. With timely diagnosis, appropriate medications, and careful monitoring for complications, patients can recover fully and minimize the risk of recurrence.
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