Pericarditis

Overview

Pericarditis is a condition characterized by swelling and irritation of the pericardium, the thin, saclike tissue surrounding the heart. It often causes sharp chest pain due to the irritated layers of the pericardium rubbing against each other. The pain typically occurs behind the breastbone or on the left side of the chest and may worsen with coughing, lying down, or taking deep breaths. Other symptoms may include chest tightness, shortness of breath, and fatigue. Pericarditis may be caused by infections, inflammatory disorders, injury to the heart or chest, or other chronic health conditions. Early diagnosis and treatment can help reduce the risk of complications.

Understanding the disease

Symptoms

The symptoms of pericarditis may include sharp or stabbing chest pain, usually behind the breastbone or on the left side of the chest. The pain may spread to the left shoulder and neck, worsen when coughing, lying down, or taking a deep breath, and improve when sitting up or leaning forward. Other symptoms may include a low-grade fever, fatigue, general feeling of weakness or being sick, leg swelling, and a pounding or racing heartbeat (heart palpitations). Pericarditis may be acute, recurrent, or chronic, depending on the pattern and duration of symptoms. Early diagnosis and treatment may help reduce the risk of complications.

Development

Pericarditis can develop in different ways, and the duration and causes can vary from one case to another. Here's a brief summary of the different types of pericarditis:

1. Acute pericarditis: This type typically develops suddenly and lasts for a few days to a few weeks. It's often caused by a viral infection, and the symptoms usually resolve without long-term complications.
2. Recurrent pericarditis: This type occurs about four to six weeks after an episode of acute pericarditis, with no symptoms in between. It's often triggered by the same viral infection that caused the initial episode.
3. Incessant pericarditis: This type lasts for about four to six weeks but is continuous. It's usually caused by a bacterial infection or a reaction to a medication.
4. Chronic constrictive pericarditis: This type develops slowly and lasts longer than three months. It's often caused by a chronic infection, autoimmune disorders, or radiation therapy. The scarring and thickening of the pericardium lead to constriction of the heart, which can cause significant complications. It's important to note that in some cases, the cause of pericarditis may not be found (idiopathic pericarditis). The duration and progression of pericarditis can also vary depending on the individual and their underlying health conditions. If you experience symptoms of pericarditis, it's crucial to seek medical attention to receive an accurate diagnosis and appropriate treatment.

Assessment and Diagnosis

Triage

You should see a doctor if pericarditis is suspected, especially if you experience new symptoms of chest pain. Chest pain is the most common symptom of pericarditis, and it may feel sharp or stabbing, dull, achy, or pressure-like. The pain usually occurs behind the breastbone or on the left side of the chest and may spread to the left shoulder and neck. Other symptoms include worsening pain when coughing, lying down, or taking deep breaths, and improvement when sitting up or leaning forward. If you have any type of chest pain or suspect pericarditis, it's important to be thoroughly evaluated by a healthcare provider to determine the cause and appropriate treatment.

Diagnosis

To diagnose pericarditis, a health care provider will typically examine you and ask questions about your symptoms and medical history. A stethoscope is used to listen to heart sounds, as pericarditis causes a specific noise called pericardial rub. Blood tests are done to check for signs of inflammation, infection, and heart attack. Additional tests may include electrocardiogram (ECG), chest X-ray, echocardiogram, cardiac CT scan, and cardiac MRI.

Management and Treatment

Complications

Potential complications of pericarditis include fluid buildup around the heart (pericardial effusion), thickening and scarring of the heart lining (constrictive pericarditis), pressure on the heart due to fluid buildup (cardiac tamponade), and other chronic health conditions such as kidney failure and cancer. Early diagnosis and treatment may help reduce the risk of these complications.

Prevention

No specific prevention method is available for pericarditis. However, taking precautions to avoid infections can help reduce the risk of heart inflammation. Some steps to follow are:

1. Avoiding people who have viral or flu-like illnesses until they've recovered.
2. Practicing good hygiene through regular hand-washing to prevent the spread of illness. Remember that early diagnosis and treatment of pericarditis can help reduce the risk of complications.

Home Remedies

It is advised to consult a healthcare professional for proper diagnosis and treatment of pericarditis.

Treatment

Treatments for pericarditis may vary depending on the severity and underlying cause of the condition. Typically, mild cases of pericarditis may not require treatment and can resolve on their own. However, for more severe cases or those that persist, the following treatments may be considered:

1. Medications: Doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce inflammation, pain, and fever. Colchicine, a medication specifically used to treat pericarditis, may also be prescribed. In more severe cases, corticosteroids can be used to reduce inflammation.
2. Rest: It's important to rest during an episode of pericarditis, as physical activity may exacerbate symptoms.
3. Pain relief: Over-the-counter pain relievers like acetaminophen may be recommended to help manage pain.
4. Oxygen therapy: In cases where pericarditis is caused by a respiratory infection, oxygen therapy may be necessary to support breathing.
5. Surgery: In rare cases, surgery may be required to remove fluids accumulated around the heart, drain infected or abscessed pericardial sacs, or repair damage to the pericardium. It's crucial to seek medical attention for pericarditis, as early diagnosis and treatment can help reduce the risk of long-term complications.

Preparing for medical consultation

To prepare for an appointment for pericarditis, you should:

1. Be aware of any pre-appointment restrictions: When you make your appointment, ask if you need to do anything in advance, such as restrict your diet.
2. Write down any symptoms you're having: List details of your symptoms, including where your chest pain starts and how far it spreads, as well as other signs and symptoms like fever, trouble breathing, or weight loss.
3. Gather key medical information: Prepare a list that includes recent health concerns, medical conditions, and the names of any prescription and over-the-counter medications you're taking.
4. Bring a family member or friend along: Consider having someone accompany you to help remember important details and serve as your advocate.
5. Bring previous scans or X-rays and medical records: Ensure that you bring any relevant previous scans or X-rays and medical records to the appointment. Remember to make a list of questions to ask your healthcare provider, such as the likely cause of your symptoms, recommended tests, and the appropriate treatment approach.