Pericarditis

Pericarditis is an inflammation of the pericardium – the thin two-layered sac filled with a small amount of fluid that surrounds the heart.
The pericardium has a protective function, stabilizing the heart and preventing it from overstretching. When the pericardium becomes inflamed, its layers rub against each other, causing pain and potentially leading to an excess fluid buildup in the sac, a condition known as pericardial effusion.

Causes and Types

Pericarditis can be acute (sudden onset and short-term) or chronic (lasting more than three months). In most cases, the cause is a viral infection, often occurring after a cold or flu. Other causes can include bacterial infections, autoimmune diseases (such as lupus), kidney failure, chest trauma, or after a heart attack or surgery. Often, the cause remains unknown (idiopathic pericarditis).

Symptoms and Complications

The main and most characteristic symptom is sharp chest pain, which is often sudden and may radiate to the left shoulder and neck. The pain usually worsens when lying down or taking a deep breath and improves when leaning forward. Other symptoms include low fever, weakness, and palpitations. The most serious complication is cardiac tamponade, where a large pericardial effusion exerts pressure on the heart, hindering its filling, leading to a drop in blood pressure, and requiring urgent intervention.

Diagnosis and Treatment

The diagnosis is based on symptoms, physical examination (detecting pericardial friction rub with a stethoscope), ECG changes, and echocardiography. Echocardiography is crucial as it allows visualization of the inflammation and assessment of the presence of pericardial effusion.

Treatment of acute pericarditis often includes:

• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or Aspirin are the primary treatment for relieving pain and reducing inflammation.
• Colchicine: This medication is often added as it reduces the risk of recurrence (relapse) of pericarditis.
• Rest: Limiting physical activity is important during the acute phase.

In cases of cardiac tamponade or large effusion, pericardiocentesis may be necessary – a procedure to drain excess fluid with a needle.

 Synonyms: Inflammation of the pericardium, Fluid around the heart, Pericardial effusion