What Is Pericarditis?

The heart is surrounded by a protective sac called the pericardium. Pericarditis means inflammation of the pericardium, and it is the most common disease of the pericardium. It can be caused by viral, bacterial, or fungal infections.

Symptoms of pericarditis are similar to a heart attack. Knowing the symptoms, diagnostic methods, types, and prevention is very important. This article will provide basic information that can help you.

Overview

Normally, the heart is surrounded by a double-layer, fibro-elastic sac called the pericardium.  The pericardium consists of a visceral layer (the innermost layer that is directly attached to the heart) and a partial layer (the outer layer). The two layers are separated by a space that contains 15 to 50 ml of fluid. 

Inflammation of the pericardium is called pericarditis. It can happen alongside inflammation of the heart muscle (myocarditis), which has similar symptoms. When pericarditis and myocarditis occur together, this condition is called myopericarditis.¹

Causes of pericarditis

The common causes of pericarditis include: 

• Viral infections such as the flu 
• Inflammatory conditions like rheumatoid arthritis
• A bacterial infection, including tuberculosis, which leads to bacterial pericarditis 
• A fungal infection, which causes fungal pericarditis 
• An infection with a parasite leads to parasitic pericarditis 
• Kidney failure, which causes uremic pericarditis 
• Genetic diseases like familial Mediterranean fever (FMF)
• Tumours like lymphoma which cause malignant pericarditis

Rare causes of pericarditis include:

• Certain medications or vaccines 
• Injury to the chest (e.g. a car accident, heart attack, or heart surgery) 
• Another health condition, such as kidney failure, cancer, or an underactive thyroid 

Sometimes the cause of pericarditis is not known, which is called idiopathic pericarditis.

What are the types of pericarditis?

There are five different types of pericarditis, which can either be acute (lasting for a shorter time) or chronic (last over a longer time). The types include: 

• Acute fibrinous pericarditis: The inflamed pericardium is covered with a layer of fibrin, a protein involved in blood clotting 
• Acute purulent pericarditis: The pericardium is infected and covered with a layer of pus 
• Acute constrictive pericarditis: The pericardium is covered with tough fibrosis material (overgrown scar tissue), which prevents the heart pumping normally 
• Chronic pericarditis: Lasts longer than three months and can lead to pericardial effusion (build-up of fluid around the heart)
• Dressler's syndrome: A delayed form of pericarditis which can occur after heart surgery, a heart attack, or a heart injury. It is caused by the immune system's response to injury

Signs and symptoms of pericarditis

Chest pain is a common symptom of pericarditis. It usually occurs on the left side of the chest and can radiate to the left side of the neck and shoulder. The pain can be sharp, stabbing, severe, aching, or overwhelming. 

Other symptoms include: 

• Heart palpitations  
• Difficulty breathing 
• Coughing 
• Abdominal swelling 
• Leg swelling 
• Increased pain as you breathe in 
• Flu-like symptoms (fever, weakness or fatigue) 
• Increased pain when lying down

Management and treatment for pericarditis

The goals of treatment include: 

• Decrease pain and inflammation 
• Prevent complications 
• Identify and treat the underlying cause of the condition

The treatment of pericarditis depends on the suspected causes. Some people may only need medication, others might need fluid drainage when the fluid builds up in the pericardium. Constrictive pericarditis may require surgery.²

Medication for pericarditis:

• Depending on the causes, you may need an antifungal or antibiotic medication 
• Acute pericarditis is treated with medication for inflammation and pain, such as high-dose aspirin or ibuprofen 
• Chronic or recurrent pericarditis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine (another type of anti-inflammatory drug). These may be required for several years 
• A diuretic helps reduce excess fluid caused by constrictive pericarditis
• If the cause is cancer, chemotherapy or other cancer treatments may be required

Procedures and surgeries for pericarditis: 

A procedure called a pericardiocentesis is required when fluid builds in the space between the pericardium, a condition called pericardial effusion. If the fluid builds up quickly, it can cause a  cardiac tamponade, which impairs the ability of the heart to function and causes hypotension (low blood pressure). The procedure is done by using a catheter (a long, thin tube) to drain the extra fluid. A computerised tomography (CT) scan or an echocardiogram helps to guide the catheter to the pericardium. 

Constrictive pericarditis requires a procedure called a pericardiectomy. This is when some of the pericardium is removed.  

You should respond to treatment within weeks of the procedure and full recovery from surgery can take up to a month. 

FAQs

How is pericarditis diagnosed?

Pericarditis is diagnosed by taking a medical history and completing a physical examination. In the examination, your doctor may hear a pericardial rub (a grating or scratchy noise) through a stethoscope. Tests for pericarditis include: 

• Blood tests 
• Chest X-ray 
• Cardiac catheterisation 
• Electrocardiogram (ECG/EKG)
• Cardiac magnetic resonance imaging (MRI)
• Echocardiogram
• Cardiac CT scan

How can I prevent pericarditis?

Acute pericarditis can't be prevented, but the physician can take steps to reduce the chance of having another acute episode, chronic pericarditis, and complications.

These steps include: 

• Getting prompt treatment 
• Following the treatment plan 
• Getting ongoing medical care as needed

It's important to manage your lifestyle by: 

• Avoiding smoking 
• Being more active 
• Eating a healthy balanced diet 
• Avoiding alcohol 
• Managing stress 
• Aiming for a healthy weight

Who is at risk of pericarditis?

The risk of developing pericarditis is higher after: 

• Open heart surgery 
• Radiation therapy 
• A heart attack 
• Percutaneous treatment such as cardiac catheterisation

In these conditions, pericarditis occurs due to errors in the body's response to the condition or procedure.

Other risks include:

• People assigned male at birth aged 16-65 
• 30% of those treated for acute pericarditis can develop chronic pericarditis

When should I see a doctor?

If you have any symptoms of constrictive pericarditis, seek emergency medical care. These symptoms include: 

• Shortness of breath
• Heart palpitations
• Water retention 
• Swelling in your legs and feet 
• Severe swelling of the abdomen 

If you have chest pain that is intense and prolonged, it is important to go to the hospital since it is also a symptom of a heart attack.

Summary

Inflammation of the pericardium is called pericarditis and chest pain is a common symptom. 

Other symptoms include: 

• Heart palpitations
• Difficulty breathing
• Coughing
• Abdominal swelling
• Leg swelling
• Increased pain as you breathe in 
• Flu-like symptoms such as fever, weakness and fatigue
• Increased pain when lying down 

The causes of pericarditis include: 

• Viral infections
• Inflammatory conditions
• Certain medications or vaccines
• Injury to the chest  
• Bacterial, fungal and parasitic infections  
• Kidney failure and other health conditions 
• Genetic diseases 
• Tumours 

There are five types of pericarditis, which can either be chronic or acute. These are:  

• Acute fibrinous pericarditis
• Acute turbulent pericarditis 
• Acute constrictive pericarditis
• Chronic pericarditis
• Dressler's syndrome 

Depending on the type of pericarditis, it can be treated with medication or surgery. Acute pericarditis can't be prevented, but there are steps you can take to reduce your chances of another acute episode occurring or the pericarditis worsening.