What are the symptoms of pericarditis. How is pericarditis diagnosed. What causes pericarditis. Is pericarditis dangerous. How is pericarditis treated. Can pericarditis be prevented. What are the long-term effects of pericarditis.

Understanding Pericarditis: An Overview

Pericarditis is an inflammation of the pericardium, the protective sac surrounding the heart. This condition can cause various symptoms, ranging from mild discomfort to severe chest pain. While pericarditis is often not life-threatening, it can lead to serious complications if left untreated.

The pericardium consists of two layers of thin tissue containing fluid, which allows the heart to move smoothly during its contractions. When inflammation occurs, these layers may rub against each other, causing pain and other symptoms.

Recognizing the Symptoms of Pericarditis

Identifying pericarditis symptoms is crucial for early diagnosis and treatment. Common signs include:

• Sharp, stabbing chest pain
• Pain that worsens when lying down or breathing deeply
• Fever and chills
• Shortness of breath
• Fatigue
• Dry cough
• Heart palpitations

Is chest pain always indicative of pericarditis? While chest pain is a primary symptom, it’s important to note that not all chest pain is due to pericarditis. The pain associated with pericarditis often feels sharp or stabbing and may radiate to the left shoulder and arm. It typically worsens when lying down or taking deep breaths.

Causes and Risk Factors of Pericarditis

Pericarditis can be triggered by various factors, including:

1. Viral infections (most common cause)
2. Bacterial infections
3. Heart attacks
4. Chest injuries
5. Autoimmune disorders
6. Certain medications
7. Radiation therapy
8. Kidney failure

Are some people more susceptible to pericarditis? While pericarditis can affect anyone, certain factors may increase the risk:

• Recent viral or bacterial infections
• History of heart surgery
• Weakened immune system
• Presence of autoimmune disorders
• Previous episodes of pericarditis

Diagnosing Pericarditis: Medical Evaluation and Tests

Proper diagnosis of pericarditis involves a combination of physical examination and diagnostic tests. Healthcare providers may use the following methods:

• Physical examination: Listening to heart sounds for characteristic friction rubs
• Blood tests: To check for signs of inflammation and rule out other conditions
• Electrocardiogram (ECG): To detect changes in heart rhythm and electrical activity
• Chest X-ray: To examine the size and shape of the heart
• Echocardiogram: To visualize the heart’s structure and function
• CT scan or MRI: For more detailed imaging of the heart and pericardium

How accurate are these diagnostic methods? While each test provides valuable information, a combination of tests is often necessary for an accurate diagnosis. The echocardiogram is particularly useful in confirming pericarditis and assessing its severity.

Treatment Options for Pericarditis

The treatment of pericarditis depends on its cause and severity. Common approaches include:

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin
• Colchicine to reduce inflammation and prevent recurrence
• Corticosteroids for severe cases or when other treatments are ineffective
• Antibiotics if a bacterial infection is the cause

Lifestyle Changes

• Rest and limiting physical activity
• Avoiding smoking and excessive alcohol consumption
• Managing stress through relaxation techniques

Medical Procedures

• Pericardiocentesis: Draining excess fluid from the pericardium
• Pericardiectomy: Surgical removal of the pericardium in severe cases

How long does it take to recover from pericarditis? Most cases of acute pericarditis resolve within 1 to 3 weeks with proper treatment. However, some individuals may experience recurrent or chronic pericarditis, requiring ongoing management.

Potential Complications and Long-Term Effects

While pericarditis is often treatable, it can lead to complications if not properly managed:

• Cardiac tamponade: A life-threatening condition where fluid accumulates in the pericardium, compressing the heart
• Constrictive pericarditis: Scarring and thickening of the pericardium, restricting heart function
• Recurrent pericarditis: Repeated episodes of inflammation
• Myocarditis: Inflammation of the heart muscle

Can pericarditis cause permanent heart damage? In most cases, pericarditis does not cause lasting heart damage. However, severe or recurrent cases may lead to complications that affect heart function, emphasizing the importance of proper treatment and follow-up care.

Prevention and Management of Pericarditis

While it’s not always possible to prevent pericarditis, certain measures can reduce the risk and manage the condition effectively:

• Prompt treatment of infections
• Managing underlying health conditions
• Following prescribed medication regimens
• Regular follow-up appointments with healthcare providers
• Adopting a heart-healthy lifestyle

Is it possible to prevent recurrent pericarditis? While complete prevention may not be possible, following treatment plans and lifestyle recommendations can significantly reduce the risk of recurrence. Colchicine has shown promise in preventing recurrent episodes in some patients.

Living with Pericarditis: Coping Strategies and Support

Dealing with pericarditis can be challenging, but there are ways to cope and improve quality of life:

• Educate yourself about the condition
• Join support groups or seek counseling
• Practice stress-reduction techniques
• Maintain a balanced diet and exercise routine (as advised by your doctor)
• Communicate openly with healthcare providers about symptoms and concerns

How can family and friends support someone with pericarditis? Emotional support, assistance with daily tasks, and encouragement to follow treatment plans can greatly benefit individuals with pericarditis. Understanding the condition and its impact on the patient’s life is crucial for providing effective support.

Research and Future Directions in Pericarditis Treatment

Ongoing research aims to improve our understanding and management of pericarditis:

• Developing new anti-inflammatory medications
• Investigating the role of the immune system in pericarditis
• Exploring genetic factors that may influence susceptibility
• Improving diagnostic techniques for early detection
• Studying long-term outcomes and quality of life in pericarditis patients

What advancements can we expect in pericarditis treatment? Future treatments may focus on targeted therapies that address specific causes of inflammation, potentially reducing side effects and improving outcomes. Additionally, research into biomarkers may lead to more personalized treatment approaches.

Pericarditis, while often manageable, requires prompt attention and proper care to prevent complications and ensure the best possible outcomes. By understanding the symptoms, causes, and treatment options, individuals can take an active role in their health and work effectively with healthcare providers to manage this condition. As research continues to advance our knowledge of pericarditis, we can look forward to improved diagnostic tools and treatment strategies that will enhance the quality of life for those affected by this heart condition.

Pericarditis – NHS

Pericarditis causes chest pain and a high temperature. It’s not usually serious, but it can cause serious health problems. Get medical advice if you have chest pain.

Urgent advice: Call NHS 111 if:

Your chest pain is:

• sharp or stabbing
• gets worse when you take a deep breath in or lie down

You may also have a high temperature and feel hot and shivery.

These could be symptoms of pericarditis.

Pericarditis often follows a viral infection, such as a sore throat or cold.

What happens at your appointment

A GP will listen to your heart. Pericarditis can change the sound it makes.

To confirm pericarditis, the GP may:

• do some blood tests
• refer you for a chest X-ray, electrocardiogram (ECG) or echocardiogram in hospital

ECGs are safe and painless, and some GPs can do them out at the surgery.

Immediate action required: Call 999 if:

You have sudden chest pain that:

• spreads to your arms, back, neck or jaw
• makes your chest feel tight or heavy
• also started with shortness of breath, sweating and feeling or being sick
• lasts more than 15 minutes

You could be having a heart attack. Call 999 immediately as you need immediate treatment in hospital.

Treating pericarditis

Treatment for pericarditis will depend on what’s causing it. You may be given anti-inflammatory painkillers, such as ibuprofen, and you should feel better within 1 to 2 weeks.

Sitting up or leaning forward can also help ease the pain.

You may need other treatment. For example, a GP may prescribe these medicines:

• colchicine – if anti-inflammatory painkillers do not work or you’re not able to take them
• steroids – if colchicine does not work
• antibiotics – if pericarditis is caused by a bacterial infection

Causes of pericarditis

Your heart has a protective fluid-filled sac around it called the pericardium.

In pericarditis, the pericardium gets inflamed, and blood or fluid can leak into it.

It’s difficult to confirm the exact cause of pericarditis, but it’s usually a viral infection.

Page last reviewed: 21 September 2020
Next review due: 21 September 2023

Pericarditis – Better Health Channel

About pericarditis

The heart is surrounded by a protective sac called the pericardium. The pericardium is made up of two layers of thin tissue (membrane) that contain fluid. The fluid allows the layers to glide smoothly over each other when the heart beats. The pericardium helps keep the heart in place and protects it.

When the pericardium becomes inflamed, this is called pericarditis. The inflammation causes the membrane layers to swell and rub against each other as the heart contracts and relaxes.

The symptoms of pericarditis can be similar to those of a heart attack and can include chest pain, shortness of breath and palpitations. It is always important to seek medical help as soon as possible if you experience these symptoms.

Pericarditis is usually mild and can be managed with rest and medicines, if needed.

Symptoms of pericarditis

Depending on the type of pericarditis you have, symptoms can vary and can include:

• sharp and stabbing chest pains
• pain radiating into the left shoulder and arm
• pain that gets worse if you’re lying down or taking deep breaths
• a fever
• sweating and chills
• feeling short of breath or trouble breathing
• dizziness
• feeling faint
• dry cough
• palpitations or a racing heart, which can be a sign of an abnormal heart rhythm.

Symptoms of acute pericarditis can last from one to three weeks. Chronic pericarditis lasts three months or longer.

Causes of pericarditis

The cause of your pericarditis may not always be clear. Causes of pericarditis include:

• viral infection
• bacterial infection
• heart attack
• chest injury
• heart surgery
• kidney failure
• autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus
• cancer
• radiation therapy.

Viral pericarditis

A viral infection is the most common cause of pericarditis. For example, a chest infection caused by a virus can lead to pericarditis.

You may be prescribed medicines to help reduce the inflammation and to relieve pain.

Bacterial pericarditis

Pericarditis caused by a bacterial infection is potentially fatal, so it is very important to seek medical treatment as soon as possible.

Most cases of bacterial pericarditis are caused by infections somewhere else in the body. For example, if you have bacterial pneumonia (a lung infection), you may develop pericarditis if the bacteria in your system infects the pericardium directly or through your bloodstream.

Seeking medical help as soon as possible to treat infections (such as pneumonia) for example, will help reduce the chance of developing bacterial pericarditis.

Constrictive pericarditis

As the pericardium recovers from injury or inflammation, scar tissue may form. Scar tissue makes the pericardium less flexible, so the heart can’t beat properly and pump blood around the body as it should.

Symptoms of constrictive pericarditis can include:

• fatigue
• feeling short of breath or trouble breathing
• dizziness
• feeling faint
• swelling of the abdomen or lower legs (due to fluid build up)
• heart palpitations (due to an abnormal heart rhythm)

Without treatment, constrictive pericarditis can lead to complications including:

• abnormal heart rhythm (heart arrhythmia)
• heart failure
• liver damage.

Post-heart attack pericarditis

The injury to heart tissue caused by a heart attack can sometimes lead to pericarditis. This is known as post-heart attack (or post-myocardial infarction) pericarditis.

The symptoms of pericarditis may not appear for some weeks or months after the heart attack.

Pericarditis after heart surgery

Pericarditis may rarely occur after heart surgery. Certain heart surgeries involve opening the pericardium, including coronary artery bypass graft surgery and heart valve surgery. Pericardial thickening or scarring can happen after heart surgery and this can contribute to pericarditis after surgery.

Chronic effusive pericarditis

Long-term inflammation causes a gradual build-up of fluid within the two layers of the pericardium. In most cases, the reasons for this are unknown. Two of the known causes of chronic effusive pericarditis are tuberculosis and hypothyroidism (underactive thyroid gland).

Diagnosis of pericarditis

To diagnose pericarditis, your doctor will ask about your medical history and do a physical examination. Your doctor will listen to your heart with a stethoscope.

A stethoscope is typically placed on the chest and back to listen to heart sounds. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding the heart (pericardium) rub against each other if the pericardium is inflamed.

Your doctor may also organise some tests including:

• blood tests
• an electrocardiogram (ECG)
• a chest X-ray
• an echocardiogram (ultrasound of the heart)
• a heart computerised tomography (CT) scan
• magnetic resonance imaging (MRI) scan of the chest
• taking a sample of pericardium fluid (using a fine needle) that will be examined in a laboratory.

Treatment for pericarditis

Treatment for pericarditis depends on the cause and severity, but may include:

• limiting physical activity if necessary. This can help limit the strain on your heart and prevent or limit damage to your heart muscle
• medicines for pain relief
• medicines to reduce inflammation, such as colchicine or, in some cases, non-steroidal anti-inflammatory medicines (NSAIDS) or corticosteroids – if your doctor decides they are necessary
• antibiotics – if your pericarditis is caused by a bacterial infection.

Surgeries and other procedures

If pericarditis causes fluid build-up around the heart, a surgery or other procedure may be needed to drain the fluid.

Surgeries or other procedures to treat pericarditis include:

• Pericardiocentesis. In this procedure, a sterile needle or a small tube (catheter) is used to remove and drain the excess fluid from around the heart.
• Removal of the pericardium (pericardiectomy). The entire pericardium may need to be removed if the sac surrounding the heart is permanently stiff due to constrictive pericarditis. This surgery is only rarely required.

Complications of pericarditis

Some of the complications of pericarditis include:

• cardiac tamponade – this can happen when more fluid than usual builds up between the two layers of the pericardium. The heart is compressed and can’t pump properly. This requires urgent medical attention and left untreated can be fatal.
• abscess – this is a build-up of pus either within the heart or in the pericardium
• spread of infection – as with any infection, the infection in the pericardium can spread to other parts of the body and infect the blood.

Where to get help

• Your GP (doctor)
• In an emergency, always call triple zero (000)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours a day, 7 days a week)

causes, symptoms, treatment, prevention at home

What is pericarditis

Pericarditis is an inflammation of the pericardium, a thin two-layer sac that surrounds the heart. There is a small amount of liquid between the layers to prevent friction when beating. When the layers become inflamed, this can lead to disruption of the full functioning of the heart, the formation of adhesions in the cavity, the accumulation of fluid and pain in the chest. Pericarditis can be an independent disease or a manifestation of some other pathology ^{1. 2} .

There are several forms of pericarditis:

• acute – one that is diagnosed for the first time, lasts no more than 4-6 weeks and is usually accompanied by signs of inflammation and pain in the chest;
• recurrent – occurs after relief of 1 episode of pericarditis after 4-6 weeks of treatment;
• permanent – develops after treatment of an acute episode and is characterized by a continuous course without remission;
• chronic – accompanied by pericardial effusion (accumulation of fluid inside the heart sac) and lasts at least 3 months;
• constrictive – in this form of the disease, the pericardium is covered with scars, so the heart muscle cannot expand ¹ .

Patients with pericardial effusion may develop cardiac tamponade. This is a life-threatening condition in which the heart is compressed due to the accumulation of fluid, pus and thrombotic masses around it ¹ . Cardiac tamponade is a medical emergency.

Causes of pericarditis in adults

Very often the cause of the disease remains unknown – in this case they speak of idiopathic pericarditis. Among other causes of the disease are:

• viral, bacterial, rarely fungal and parasitic infections;
• autoimmune and autoinflammatory diseases such as systemic scleroderma, rheumatoid arthritis, acute rheumatic fever, familial Mediterranean fever;
• chest and abdominal injuries;
• heart surgery;
• radiotherapy;
• lesions of the heart and neighboring organs: myocardial infarction, myocarditis, pneumonia, pulmonary infarction;
• neoplasms of the pericardium and other organs: cancer of the breast, lung, stomach, colon;
• taking certain medications: anticancer drugs, antibiotics, thiazide diuretics, antiarrhythmics ^1.2 .

In developed countries, idiopathic or viral pericarditis is common (85-90% of cases). Tuberculosis is the most common cause in developing countries, often associated with HIV infection ¹ .

Symptoms of pericarditis in adults

Pericarditis may feel like a heart attack with sudden sharp or stabbing pain in the chest. The pain can be in any part of the chest and behind the sternum, spread to the shoulders, neck, arms or jaw. Pain is aggravated by inhalation, coughing and swallowing and decreases in the prone position ¹ .

Other possible but not mandatory symptoms include:

• fever;
• muscle pain;
• weakness or fatigue;
• cardiac arrhythmias;
• shortness of breath.

The typical posture of a patient with pericarditis is sitting, leaning forward. The skin is usually pale, cold and bluish, there may be swelling of the face and left arm ¹ . With the viral nature of pericarditis, the patient may experience signs of SARS or “intestinal flu”. But even the presence of only one symptom – chest pain – is a signal to immediately call an ambulance.

Treatment of pericarditis in adults

The doctor will first take a medical history, ask about the symptoms, when they appeared, and what aggravates them. Then he will listen to the heart with a stethoscope – its tones will be muffled or deaf, and in about every third patient on the first day of illness, the pericardium will be heard rubbing against the outer layer of the heart. In the following days, the noise intensity sharply decreases ¹ .

An ECG will help determine pericarditis. Photo: Shutterstock

Diagnostics

In addition to the physical examination, other tests are used for diagnosis:

• complete blood count – most patients will have elevated levels of leukocytes, C-reactive protein and erythrocyte sedimentation rate;
• ferritin level test;
• testing for myocardial injury;
• chest x-ray;
• three-dimensional echocardiography;
• electrocardiogram (ECG) ¹ .

Methods such as CT and MRI play an auxiliary role in the diagnosis of pericarditis.

Current treatments

All patients with pericarditis are advised to drastically limit physical activity. They should remain in bed or semi-bed rest until the chest pain and fever stop, and C-reactive protein levels decrease. Usually this period takes several days ¹ .

Treatment approaches will vary slightly depending on the form of the disease. In acute nonspecific pericarditis, patients may be given acetylsalicylic acid, ibuprofen, and autumn colchicum seed extract (a source of colchicine).

Glucocorticosteroid hormones are considered second-line therapy. In other forms of the disease, antirheumatic drugs and drugs to suppress an excessive immune response may be used. Bacterial pericarditis is treated with antibiotics and anti-tuberculosis drugs ^1.2 .

Surgery may be considered for cardiac tamponade, large amounts of effusion, and in some other cases. In bacterial pericarditis, surgery for diagnostic purposes is possible.

Prevention of pericarditis in adults at home

Prevention of pericarditis is difficult, but in case of illness, it is important to strictly follow the treatment plan prescribed by the doctor. Until complete recovery, rest more, avoid heavy physical exertion.

If you notice any signs of a relapse, see your doctor as soon as possible.

Recovery from pericarditis takes time. In some cases, the complete disappearance of symptoms may take several weeks.

Popular questions and answers

We asked cardiologist Stanisław Snichovsky to answer the most popular questions of our readers about pericarditis.

What are the complications of pericarditis?

– In general, pericarditis is considered a disease with a favorable outcome, since timely qualified assistance leads to a complete recovery in most patients. In rare cases, in severe cases of the disease, the following complications may occur:

• thickening or sticking together of the pericardial layers (external and internal), which leads to difficulty in the work of the heart and the development of heart failure;
• cardiac tamponade (accumulation of a large amount of fluid between the sheets of the pericardium), which also leads to difficulty in the work of the heart, the development of heart failure and possible cardiac arrest;
• formation of fistulas (holes) in the internal mammary artery – this is possible only with purulent pericarditis and is a rare complication.

After pericarditis, cardiac conduction disturbances may be observed for a long time. They are manifested by periodic attacks of arrhythmia (especially during exercise).

When to call a doctor at home for pericarditis?

– Pericarditis usually develops gradually. Therefore, if there are major complaints and symptoms, you should consult a doctor for a diagnosis.

Most often, patients complain of shortness of breath (at rest or with little physical exertion), pain in the heart, palpitations, general weakness.

Is it possible to cure pericarditis with folk remedies?

– There are many options for the treatment of pericarditis. As a rule, they depend on the cause of pericarditis (treatment of the disease that caused pericarditis leads to the disappearance of its symptoms, until complete recovery). With pericarditis, the doctor prescribes treatment only after a complete examination and establishment of the cause of the disease.

Folk remedies in the treatment of pericarditis can only be used as adjunctive therapy.

Sources:

1. Pericarditis. Clinical guidelines 2022. http://disuria.ru/_ld/12/1227_kr22I30I32MZ.pdf
2. Diagnosis and treatment of pericarditis. Key points of the 2022 clinical guidelines. HE. Kryuchkova, E.A. Itskova, Yu.A. Lutai, E.Yu. Turna, E. A. Kostyukova, N.V. Zhukov http://crimtj.ru/Journal.files/2023-1/HP-KryuchItskovLutayTurnaKostyuZh-DiagnosTreatmePericarMainPointsClinicaRe.pdf

causes, symptoms, diagnosis and treatment

Pericarditis – inflammation of the pericardial sac (the outer lining of the heart-pericardium), often of an infectious, rheumatic or post-infarction nature. Manifested by weakness, constant pain behind the sternum, aggravated by inspiration, coughing (dry pericarditis). May leak fluid between the layers of the pericardium (exudative pericarditis) and be accompanied by severe shortness of breath. Effusive pericarditis is dangerous with suppuration and the development of cardiac tamponade (compression of the heart and blood vessels by accumulated fluid) and may require emergency surgical intervention.

General information

Pericarditis – inflammation of the pericardial sac (outer layer of the heart-pericardium), often of an infectious, rheumatic or post-infarction nature. Manifested by weakness, constant pain behind the sternum, aggravated by inspiration, coughing (dry pericarditis). May leak fluid between the layers of the pericardium (exudative pericarditis) and be accompanied by severe shortness of breath. Effusive pericarditis is dangerous with suppuration and the development of cardiac tamponade (compression of the heart and blood vessels by accumulated fluid) and may require emergency surgical intervention.

Pericarditis can manifest itself as a symptom of any disease (systemic, infectious or cardiac), be a complication of various pathologies of internal organs or injuries. Sometimes in the clinical picture of the disease, it is pericarditis that becomes of paramount importance, while other manifestations of the disease fade into the background. Pericarditis is not always diagnosed during the life of the patient, in about 3-6% of cases, signs of previously transferred pericarditis are determined only at autopsy. Pericarditis is observed at any age, but is more common among adults and the elderly, and the incidence of pericarditis in women is higher than in men.

Pericarditis

Causes of pericarditis

Inflammation in the pericardium can be infectious or non-infectious (aseptic). The most common causes of pericarditis are rheumatism and tuberculosis. With rheumatism, pericarditis is usually accompanied by damage to other layers of the heart: the endocardium and myocardium. Pericarditis of rheumatic and, in most cases, tuberculous etiology is a manifestation of an infectious-allergic process. Sometimes tuberculous lesions of the pericardium occur when the infection migrates through the lymphatic ducts from foci in the lungs, lymph nodes.

The risk of developing pericarditis increases in the following conditions:

• infections – viral (influenza, measles) and bacterial (tuberculosis, scarlet fever, tonsillitis), sepsis, fungal or parasitic infection. Sometimes the inflammatory process passes from organs adjacent to the heart to the pericardium with pneumonia, pleurisy, endocarditis (lymphogenous or hematogenous)
• allergic diseases (serum sickness, drug allergy)
• systemic connective tissue diseases (systemic lupus erythematosus, rheumatism, rheumatoid arthritis, etc. )
• heart disease (as a complication of myocardial infarction, endocarditis and myocarditis)
• damage to the heart due to trauma (wound, strong blow to the region of the heart), operations
• malignant tumors
• metabolic disorders (toxic effects on the pericardium in uremia, gout), radiation injury
• malformations of the pericardium (cysts, diverticula)
• general edema and hemodynamic disturbances (resulting in fluid accumulation in the pericardial space)

Pathogenesis

In pericarditis, the inflammatory process affects the serous tissue membrane of the heart – the serous pericardium (parietal, visceral plate and pericardial cavity). Changes in the pericardium are characterized by increased permeability and dilation of blood vessels, leukocyte infiltration, fibrin deposition, adhesions and scarring, calcification of the pericardial layers, and cardiac compression.

Classification

There are primary and secondary pericarditis (as a complication in diseases of the myocardium, lungs and other internal organs). Pericarditis can be limited (at the base of the heart), partial, or capture the entire serous membrane (general diffuse).

Depending on the clinical features, pericarditis is divided into acute and chronic.

Acute pericarditis

Acute pericarditis develops rapidly, lasts less than 6 months and includes:

1. Dry or fibrinous – the result of increased blood filling of the serous membrane of the heart with sweating of fibrin into the pericardial cavity; liquid exudate is present in small quantities.

2. Exudative or exudative – secretion and accumulation of liquid or semi-liquid exudate in the cavity between the parietal and visceral layers of the pericardium. Exudative exudate can be of a different nature:

• serous-fibrinous (a mixture of liquid and plastic exudate, in small quantities it can be completely absorbed)
• hemorrhagic (bloody exudate) with tuberculous and scurvy inflammation of the pericardium.

1. with cardiac tamponade – accumulation of excess fluid in the pericardial cavity can cause an increase in pressure in the pericardial fissure and disruption of the normal functioning of the heart
2. without cardiac tamponade

• purulent (putrid)

Blood cells (leukocytes, lymphocytes, erythrocytes, etc.) in different quantities are necessarily present in the exudate in each case of pericarditis.

Chronic pericarditis

Chronic pericarditis develops slowly over 6 months and is divided into:

1. Effusive or exudative.

2. Adhesive (adhesive) – represents the residual effects of pericarditis of various etiologies. When the inflammatory process passes from the exudative stage to the productive stage, granulation and then scar tissue is formed in the pericardial cavity, the sheets of the pericardium stick together with the formation of adhesions between themselves, or with neighboring tissues (diaphragm, pleura, sternum):0007

• asymptomatic (without persistent circulatory disorders)
• with functional disorders of the heart
• with deposition of calcium salts in the altered pericardium (“shell-like” heart)
• with extracardiac adhesions (pericardial and pleurocardial)
• constrictive – with germination of pericardial sheets by fibrous tissue and their calcification. As a result of compaction of the pericardium, the filling of the chambers of the heart with blood during diastole is limited and venous congestion develops.
• with pericardial dissemination of inflammatory granulomas (“pearl oyster”), for example, in tuberculous pericarditis

3. Exudative-adhesive.

Non-inflammatory pericarditis also occurs:

1. Hydropericardium – accumulation of serous fluid in the pericardial cavity in diseases that are complicated by chronic heart failure.
2. Hemopericardium – accumulation of blood in the pericardial space as a result of an aneurysm rupture, injury to the heart.
3. Chylopericardium – accumulation of chylous lymph in the pericardial cavity.
4. Pneumopericardium – the presence of gases or air in the pericardial cavity when the chest and pericardium are injured.
5. Effusion with myxedema, uremia, gout.

Various neoplasms can occur in the pericardium:

• Primary tumors: benign – fibromas, teratomas, angiomas and malignant – sarcomas, mesothelioma.
• Secondary – damage to the pericardium as a result of the spread of metastases of a malignant tumor from other organs (lungs, breast, esophagus, etc.).
• Paraneoplastic syndrome is a lesion of the pericardium that occurs when a malignant tumor affects the body as a whole.

Cysts (pericardial, coelomic) are a rare pathology of the pericardium. Their wall is represented by fibrous tissue and, like the pericardium, is lined with mesothelium. Pericardial cysts can be congenital or acquired (a consequence of pericarditis). Pericardial cysts are constant in volume and progressive.

Symptoms of pericarditis

Manifestations of pericarditis depend on its form, the stage of the inflammatory process, the nature of the exudate and the rate of its accumulation in the pericardial cavity, the severity of the adhesive process. In acute inflammation of the pericardium, fibrinous (dry) pericarditis is usually noted, the manifestations of which change in the process of excretion and accumulation of exudate.

Dry pericarditis

Manifested by pain in the heart and pericardial rub. Pain in the chest – dull and pressing, sometimes radiating to the left shoulder blade, neck, both shoulders. More often there are moderate pains, but there are strong and painful, resembling an attack of angina pectoris. In contrast to pain in the heart with angina pectoris, pericarditis is characterized by its gradual increase, duration from several hours to several days, lack of reaction when taking nitroglycerin, temporary remission from taking narcotic analgesics. Patients can simultaneously feel shortness of breath, palpitations, general malaise, dry cough, chills, which brings the symptoms of the disease closer to the manifestations of dry pleurisy. A characteristic sign of pain in pericarditis is its increase with deep breathing, swallowing, coughing, change in body position (reduction in the sitting position and increase in the supine position), breathing is shallow and frequent.

Pericardial rub is detected when listening to the patient’s heart and lungs. Dry pericarditis can end in a cure after 2-3 weeks or go into exudative or adhesive.

Exudative pericarditis

Exudative (effusion) pericarditis develops as a consequence of dry pericarditis or independently with rapidly starting allergic, tuberculous or tumor pericarditis.

There are complaints of pain in the region of the heart, a feeling of tightness in the chest. With the accumulation of exudate, there is a violation of blood circulation through the hollow, hepatic and portal veins, shortness of breath develops, the esophagus is compressed (the passage of food is disturbed – dysphagia), the phrenic nerve (hiccups appear). Almost all patients have fever. The appearance of patients is characterized by edematous face, neck, anterior surface of the chest, swelling of the veins of the neck (“Stokes’ collar”), pale skin with cyanosis. On examination, smoothing of the intercostal spaces is noted.

Complications

In the case of exudative pericarditis, acute cardiac tamponade may develop, in the case of constrictive pericarditis, circulatory failure occurs: exudate compression of the caval and hepatic veins, right atrium, which complicates ventricular diastole; development of false liver cirrhosis.

Pericarditis causes inflammatory and degenerative changes in the layers of the myocardium adjacent to the effusion (myopericarditis). Due to the development of scar tissue, fusion of the myocardium with nearby organs, the chest and the spine (mediastino-pericarditis) is observed.

Diagnosis

Timely diagnosis of inflammation of the pericardium is very important, as it can pose a threat to the life of the patient. Such cases include compressive pericarditis, exudative pericarditis with acute cardiac tamponade, purulent and neoplastic pericarditis. It is necessary to differentiate the diagnosis from other diseases, mainly with acute myocardial infarction and acute myocarditis, to identify the cause of pericarditis. Diagnosis of pericarditis includes taking an anamnesis, examining the patient (listening and percussion of the heart), and conducting laboratory tests.

1. Tests . General, immunological and biochemical (total protein, protein fractions, sialic acids, creatine kinase, fibrinogen, seromucoid, CRP, urea, LE cells) blood tests are performed to clarify the cause and nature of pericarditis.
2. Electrocardiography. ECG is of great importance in the diagnosis of acute dry pericarditis, the initial stage of exudative pericarditis and adhesive pericarditis (with compression of the heart cavities). In the case of exudative and chronic inflammation of the pericardium, a decrease in the electrical activity of the myocardium is observed. FCG (phonocardiography) notes systolic and diastolic murmurs that are not associated with the functional cardiac cycle, and periodically occurring high-frequency oscillations.
3. Imaging . X-ray of the lungs is informative for the diagnosis of exudative pericarditis (there is an increase in the size and change in the silhouette of the heart: a spherical shadow is typical for an acute process, a triangular one for a chronic one). With the accumulation of up to 250 ml of exudate in the pericardial cavity, the size of the shadow of the heart does not change. There is a weakened pulsation of the contour of the shadow of the heart. The shadow of the heart is poorly visible behind the shadow of the pericardial sac filled with exudate. With constrictive pericarditis, fuzzy contours of the heart are visible due to pleuropericardial adhesions. A large number of adhesions can cause a “fixed” heart that does not change shape and position during breathing and changing body position. With a “armored” heart, calcareous deposits are noted in the pericardium. Chest CT, MRI and MSCT of the heart diagnose thickening and calcification of the pericardium.
4. Echocardiography. Echocardiography is the main method for diagnosing pericarditis, which makes it possible to detect the presence of even a small amount of liquid exudate (~ 15 ml) in the pericardial cavity, changes in heart movements, the presence of adhesions, thickening of the pericardial sheets.
5. Diagnostic pericardial puncture. In the case of effusion pericarditis, allows examination of the exudate (cytological, biochemical, bacteriological, immunological). The presence of signs of inflammation, pus, blood, tumor helps to establish the correct diagnosis.

KT OGK. exudative pericarditis. A significant amount of fluid in the pericardial cavity.

Treatment of pericarditis

Therapy of acute pericarditis

The method of treatment of pericarditis is chosen by the doctor depending on the clinical and morphological form and cause of the disease. A patient with acute pericarditis is shown bed rest until the activity of the process subsides. In the case of chronic pericarditis, the regimen is determined by the patient’s condition (limitation of physical activity, dietary nutrition: complete, fractional, with limited salt intake).

In acute fibrinous (dry) pericarditis, predominantly symptomatic treatment is prescribed: non-steroidal anti-inflammatory drugs (acetylsalicylic acid, indomethacin, ibuprofen, etc.), analgesics to relieve severe pain, drugs that normalize metabolic processes in the heart muscle, potassium preparations.

Treatment of acute exudative pericarditis without signs of cardiac compression is basically the same as that of dry pericarditis. At the same time, regular strict monitoring of the main hemodynamic parameters (BP, CVP, heart rate, cardiac and stroke indices, etc.), the volume of effusion and signs of the development of acute cardiac tamponade is mandatory.

If exudative pericarditis has developed on the background of a bacterial infection, or in cases of purulent pericarditis, antibiotics are used (parentally and locally – through a catheter after drainage of the pericardial cavity). Antibiotics are prescribed taking into account the sensitivity of the identified pathogen. With tuberculous genesis of pericarditis, 2-3 anti-tuberculosis drugs are used for 6-8 months. Drainage is also used for the introduction of cytostatic agents into the pericardial cavity in case of tumor lesions of the pericardium; for aspiration of blood and the introduction of fibrinolytic drugs in hemopericardium.

Treatment of secondary pericarditis

The use of glucocorticoids (prednisolone) contributes to a more rapid and complete resorption of effusion, especially in allergic pericarditis and developing on the background of systemic diseases of the connective tissue. included in the treatment of the underlying disease (systemic lupus erythematosus, acute rheumatic fever, juvenile rheumatoid arthritis).

With a rapid increase in the accumulation of exudate (the threat of cardiac tamponade), a pericardial puncture (pericardiocentesis) is performed to remove the effusion.