Pericarditis

The image on the left shows a healthy heart, with its outer lining (pericardium) looking normal. The image on the right shows a heart with an inflamed and swollen outer lining, a condition called pericarditis.

Pericarditis happens when the thin, sac-like covering around your heart (the pericardium) gets inflamed and irritated. This irritation often leads to a sharp, stabbing pain in the chest. The pain happens because the swollen and irritated layers of the pericardium rub against each other as the heart beats.

Most cases of pericarditis are mild and clear up on their own without any special treatment. However, if the pain is severe or doesn't go away, treatment might be needed. This can include medication. In very rare cases, surgery may be necessary. Catching and treating pericarditis early can help prevent any long-term problems.

Pericarditis is a condition where the lining around the heart (pericardium) becomes inflamed. A common sign is chest pain, often sharp or stabbing, but sometimes dull, aching, or like pressure. This pain usually happens behind the breastbone or on the left side of the chest. It might:

• Spread to the left shoulder and/or neck.
• Feel worse when coughing, lying down, or breathing deeply.
• Feel better when sitting up or leaning forward.

Other possible symptoms include:

• Coughing
• Feeling tired, weak, or unwell
• Swelling in the legs or feet
• A low-grade fever
• A pounding or racing heartbeat (palpitations)
• Shortness of breath, especially when lying down
• Swelling in the belly (abdomen)

The exact symptoms depend on the type of pericarditis. Doctors categorize pericarditis based on its pattern and how long it lasts:

• Acute pericarditis: Starts suddenly and lasts for no more than four weeks. You might have more than one episode. It can be hard to tell the difference between this and a heart attack.

• Recurrent pericarditis: Happens about four to six weeks after an episode of acute pericarditis. There are no symptoms between episodes.

• Incessant pericarditis: Symptoms last for about four to six weeks, but less than three months. The symptoms are continuous.

• Chronic constrictive pericarditis: Develops slowly and lasts longer than three months.

It's crucial to seek immediate medical attention if you have new chest pain. Many pericarditis symptoms are similar to those of other heart or lung problems. A doctor can properly diagnose the cause of your chest pain and recommend the best treatment. It's essential to get a thorough check-up if you experience any chest pain.

If you experience new chest pain, seek immediate medical attention. Chest pain can be a symptom of several different heart and lung problems, including pericarditis. It's crucial to see a doctor for any kind of chest pain to get a proper diagnosis and treatment plan. Don't delay; early diagnosis is important for effective care.

Understanding Pericarditis: Finding the Cause

Pinpointing the exact cause of pericarditis, an inflammation of the sac surrounding the heart, can be tricky. Sometimes, doctors can't find a reason for the inflammation. This is called idiopathic pericarditis.

However, there are several possible reasons why pericarditis occurs:

• The body's response to heart problems: If you've had a heart attack or heart surgery, your immune system might react by causing pericarditis. This reaction is sometimes called Dressler syndrome, post-myocardial infarction syndrome, or post-cardiac injury syndrome. Essentially, your body's natural defenses are mistakenly attacking the pericardium after a heart event.

• Infections: Viruses are common culprits. These infections can inflame the pericardium.

• Injury: A direct blow to the chest or heart can cause pericarditis.

• Autoimmune diseases: Conditions like lupus and rheumatoid arthritis, where the immune system mistakenly attacks healthy tissues, can lead to pericarditis.

• Other health issues: Certain long-term conditions, including kidney failure and cancer, can sometimes be linked to pericarditis.

• Medications: Some medications, such as phenytoin (Dilantin) used to treat seizures and procainamide used to treat irregular heartbeats, can occasionally cause pericarditis as a side effect. It's important to note that these medicines are generally safe, but sometimes they can cause this inflammation in some individuals.

Early treatment of pericarditis, an inflammation of the heart lining, significantly reduces the chances of problems. If pericarditis isn't treated promptly, several complications can arise.

One common complication is a buildup of fluid around the heart, called pericardial effusion. This extra fluid can put pressure on the heart, potentially leading to further heart issues.

Another complication is the thickening and scarring of the heart lining (pericardium), known as constrictive pericarditis. Over time, some people with pericarditis develop this thickening. This makes it harder for the heart to properly fill and empty with blood. This can cause significant swelling in the legs and abdomen, along with shortness of breath, as the body struggles to circulate blood effectively.

A very serious complication is a condition called cardiac tamponade. This happens when fluid builds up around the heart, putting too much pressure on it. This pressure prevents the heart from filling correctly, leading to a decrease in the amount of blood pumped out. This can cause a sudden drop in blood pressure and is a life-threatening emergency. Immediate medical attention is crucial.

Preventing pericarditis, or inflammation of the heart lining, isn't always possible. However, you can lower your risk by taking steps to avoid infections.

Here are some ways to help:

• Avoid close contact with sick people: If someone around you has a cold, the flu, or a similar viral illness, try to stay away from them until they're feeling better. If you're sick yourself, cover your mouth and nose when you cough or sneeze to prevent spreading germs. This is important because viral infections can sometimes lead to pericarditis.

• Practice good hygiene: Regular handwashing is key to preventing the spread of illness. Wash your hands thoroughly with soap and water for at least 20 seconds, especially after being in public places or touching potentially contaminated surfaces.

• Get vaccinated: Staying up-to-date with recommended vaccines can help protect you from various illnesses, like the flu, COVID-19, and rubella. These viruses can sometimes cause inflammation of the heart muscle (myocarditis) or the heart lining (pericarditis). Sometimes, these two conditions can happen together. While rare, some people who receive the COVID-19 vaccine have experienced pericarditis or myocarditis, particularly young men aged 12-17. Always talk to your doctor about the potential benefits and risks of any vaccination.

To figure out if you have pericarditis, a doctor will first talk to you about your symptoms and medical history. They'll also listen to your heart using a stethoscope. Pericarditis often makes a specific sound, like two surfaces rubbing together. This rubbing sound is called a pericardial rub, and it happens because the two layers of the sac surrounding your heart (the pericardium) are inflamed and moving against each other.

To confirm the diagnosis or rule out other possible problems, a doctor might order some tests:

• Blood tests: These are usually done to check for signs of infection, inflammation, or a heart attack.

• Electrocardiogram (ECG): This quick and painless test measures the electrical activity of your heart. Small, sticky pads (electrodes) are placed on your chest, sometimes your arms, and sometimes your legs. These pads are connected to a machine that records the heart's electrical signals, showing how well your heart is beating.

• Chest X-ray: An X-ray of your chest can show if your heart is enlarged or if there are any other changes in its size or shape.

• Echocardiogram: This test uses sound waves to create images of your heart as it beats. It shows how well your heart is pumping blood and if there's any fluid buildup around your heart. It can also tell if the pericardium is affecting how your heart fills with blood or pumps it out.

• Cardiac CT scan: This test uses X-rays to create detailed images of your heart and chest. It can help identify any thickening of the heart, a possible sign of a condition called constrictive pericarditis.

• Cardiac MRI: This test uses magnetic fields and radio waves to create detailed images of your heart. It can show if the tissue surrounding your heart is inflamed, thickened, or has other changes.