How to Diagnose Pericarditis?

Overview

Pericarditis is an inflammation of the pericardium which is a double-membrane sac that encompasses the heart and the major blood vessels.1 This disease can be quite painful to deal with and, though not serious, can result in major health complications if left undiagnosed and untreated.

What is pericarditis?

Causes of pericarditis

Pericarditis can be caused due to a multitude of reasons, especially because it is usually a consequence of a disease, whether that be an infectious or non-infectious disease. Hence, the causes of pericarditis are split into two categories, infectious and non-infectious diseases.³

Infectious diseases 

Infectious diseases are spread through different forms of contact, whether that be touch, bodily fluids or water/air. It results in a rise in inflammatory markers concentration, which are the indicators that tell doctors about the level of inflammation present in the body.³ This implies whether a person is in good health, as inflammation is the causation of disease. This is directly linked to pericarditis as infections, which can be caused due to an invasion, increase inflammatory markers.

Infectious diseases that can trigger pericarditis include:³

Tuberculosis (TB) – TB is a bacterial pathogen which weakens the respiratory system of the body, particularly the lungs. In this case, the spread of TB can lead to tuberculosis-related pericarditis due to the proximity of the lungs and the heart. As they are closely situated, pathogens invading either organ can easily cross over and thus cause inflammation in the other.

Smallpox – Smallpox is a viral disease which is also responsible for the onset of pericarditis. Other viral conditions such as the coronavirus can also inflame the pericardium. This can be haematogenous (spread through the blood or is the origin of the swelling) or can also be due to the closeness of other infected organs, which onsets the inflammatory response. This is an immune response that occurs as a method to stop the spread of the infection, thus the inflammation.²

Fungal – Pericarditis, though rare, can also inflame the pericardium as a result of an immune response involving the inflammatory cascade due to diseases such as histoplasmosis, aspergillosis blastomycosis and many others.² 

Non-infectious diseases

Non-infectious diseases cannot be spread; instead, they are usually contracted due to a genetic disorder, lifestyle factors, exposure to toxic substances and or a mixture of the three. These can include lifelong health issues, which can result in the onset of pericarditis.²

Non-infectious diseases that can trigger pericarditis include:³

Heart attack (myocardial infarction) – It can lead to post-infarction pericarditis, as the heart is directly impacted in this occurrence; the trauma and stress the heart undergoes can result in the pericardium inflaming.

Cancer – Its occurrence is unusual when it comes to the pericardium; the spread of malignant tumours can be due to a haematogenous spread (through the blood), through the lymphatic system (drainage system of the body) or even tumour invasion. All of which can inflame the pericardium, causing neoplastic pericarditis as a secondary condition.

Post-surgery – Especially cardiac surgery can lead to post-pericardiotomy syndrome, which is an immune phenomenon that occurs after coronary bypass surgery. This bodily response leads to pericarditis as the pericardium gets inflamed due to the trauma, which occurs as a result of the surgery.

Autoimmune disorders – Autoimmune disorders such as lupus, rheumatoid arthritis and other inflammatory disorders can cause pericarditis. This is because autoimmune disorders largely elicit the body to attack itself; thus, this immune reaction can cause inflammation in the pericardium.² 

Chronic health conditions – Conditions such as renal disease can cause uraemic pericarditis right at the end, due to an accumulation of toxic substances in the pericardium, which leads to an inflammatory immune response.²

Injury to the chest – This usually leads to trauma in the heart which results in pericarditis.

Symptoms of pericarditis

There are seven categories of the symptoms of pericarditis, which as classed as syndromes and known as a form acute, incessant, chronic, recurrent constrictive pericarditis, pericardial effusion (fluid build-up) and cardiac tamponade (space around the heart fills up with fluid causing pressure).² 

All of these have typical symptoms of pericarditis, some of which include:³

• Chest pain – which is caused as a result of the swelling in the pericardium.
• Pain in general is due to inflammation and can occur whilst lying down, coughing or doing physical activity.
• Pericardial friction rub – occurs when different membranous layers of the pericardium rub together to create sound and, in pericarditis, these layers become inflamed and cause abnormal sounds.⁴
• Distinctive electrocardiographic change – electrocardiograms are devices which measure the electrical activity of the heart. So in pericarditis, the electrical activity changes and low voltages alongside other characteristic changes involving wave types can be seen.³

Duration of symptoms depending on the type of pericarditis include:⁵

• Acute pericarditis – only lasts around three weeks, though can occur in the future too and may be hard to decipher between it and a heart attack. 
• Recurrent pericarditis – usually occurs after about four to six weeks of the occurrence of acute pericarditis and has no symptoms in the time between them.
• Incessant pericarditis – usually lasts around four to six weeks but generally under a month.
• Chronic constrictive pericarditis – lasts longer than three months and is known to develop slowly.

How to Diagnose pericarditis?

Diagnosis usually involves doctors examining patients whilst asking them questions to ascertain whether or not it is pericarditis. This also involves many tests, all of which include:

Electrocardiogram

An electrocardiogram measures the electrical signals produced in the heart and is a non-invasive technique. Adhesive electrodes are attached to the body, which are linked to the computer, thus recording the electrical signals that make the heartbeat. These signals are consistent and do not change unless there is a health complication; thus, they are a good diagnosis method.⁵ 

Chest X-ray

Chest X-ray is an imaging test done using X-rays, which are absorbed by soft tissues such as the heart and the lungs, allowing them to be seen as images when scanned. These can determine the change in the shape and size of the heart and thus can help with the diagnosis.⁵ 

Echocardiogram

Echocardiograms also known as ultrasounds are done by using sound waves which generate images by means of the movement of the heart. These can detect the efficiency of the heart as well as establish whether or not there is fluid build-up in the surrounding tissue thus can help with the diagnosis.⁵ 

CT scan

CT scans are done by using X-rays which help create images of the chest and the heart. They can display the thickening of the heart, which is an indication of constrictive pericarditis.⁵ 

Cardiac MRI scan

Cardiac MRI scans are done by creating a magnetic field and by using radio waves to obtain images of cross-sections of the heart (slices). These can indicate levels of inflammation, changes in tissue surrounding the heart and levels of thickening, which can help with the diagnosis.⁵

Blood tests

Blood tests are carried out and assessed for specific blood contents which determine whether or not the patient has undergone a heart attack, inflammation or infection.⁵ 

Treatments

Treatment options depend on the type of pericarditis, the level of severity and its cause. 

Most of these include either medication or surgery:⁵

• Painkillers – These are usually over-the-counter such as ibuprofen or aspirin; however, in extreme cases, some prescription painkillers can also be given.
• Corticosteroids – These are steroid hormones used in anti-inflammatory medication, which help combat swelling. This can include prednisone, which is usually only prescribed if the pericarditis is recurring or if another medication is not useful.
• Colchicine – This is another drug that decreases inflammation in the body and is usually only prescribed if the pericarditis is recurring or if acute, though it cannot be given to patients with liver and kidney diseases as well as the fact that it’s very reactive with other medications; thus, medical history needs to be checked thoroughly before the prescription.
• Antibiotics – can also be prescribed if the pericarditis has bacterial causes.
• Removal of the pericardium – this may be required if the pericardium has become inelastic due to constrictive pericarditis.
• Pericardiocentesis – this is done when the pericardium is fluid build-up in it, and it involves a catheter/sterile needle to be inserted into the pericardium to drain the fluid from the sac.

Summary 

In summary, pericarditis can be caused due to a multitude of issues such as trauma, injury, infections (bacteria, viruses and fungi), cancer, chronic disorders, autoimmune disorders and also as a result post-surgery. It is determined what type of pericarditis it is depending on the duration as acute, incessant, chronic and recurrent constrictive pericarditis all tend to follow different timelines. Symptoms usually consist of chest pains, irregular heartbeat and abnormal sounds coming from the chest. There are many diagnostic procedures which involve CT/MRI scans, echo/electrocardiograms, X-rays and blood tests, all of which can indicate the onset of pericarditis. Furthermore, treatment usually involves treating the symptoms, so medications such as painkillers and steroids can be taken. However, some treatment options include surgery, and this is usually for those who require critical assistance. Though this is not a serious disease, if left undiagnosed can be fatal; hence, it is immanent to see a doctor if you notice recurring chest pains.