Related articles: Pericarditis
Definition
Pericarditis is an inflammation of the pericardium, the membranous sac that envelops the heart.
The disease may have an acute or chronic course.
Acute pericarditis develops rapidly, causing an inflammatory reaction that lasts a few weeks. The chronic form, instead, lasts more than 6 months and develops slowly; its main characteristic is the pericardial effusion.
Occasionally, the inflammatory process causes a marked fibrotic thickening of the pericardial sac that leads to constriction of cardiac cavities (chronic constrictive pericarditis).
Pericarditis can be caused by many ailments. Often, it derives from viral infections (echovirus, influenza virus, coxsackie B virus and HIV); less frequently, the inflammatory process involves bacteria, fungi or parasites.
Pericarditis can represent the complication of an endocarditis, infectious diseases of the upper respiratory tract, pneumonia and gastro-intestinal infections.
Inflammation of the pericardium can also appear due to thoracic trauma, autoimmune diseases (rheumatoid arthritis, SLE and systemic sclerosis), inflammatory disorders (amyloidosis and sarcoidosis), myocardial infarction, neoplasms (lung or breast cancer, leukemia and tumor metastases) and metabolic disorders (uremia during renal failure, hypothyroidism, etc.).
Pericarditis can also occur after cardiac surgery. In other cases, the disease is induced by treatments involving radiation therapy, chemotherapy and the use of immunosuppressive drugs. Sometimes, the exact cause cannot be identified (non-specific or idiopathic pericarditis).
Most common symptoms and signs *
- Arrhythmia
- Ascites
- Asthenia
- Increase in the ESR
- Chills
- Retrosternal burning
- palpitations
- Cyanosis
- Hepatic congestion
- Dysphagia
- Dyspnoea
- Distension of the neck veins
- Chest pain
- Pain in the Stomach Mouth
- Pain in the sternum
- Edema
- Hepatomegaly
- heartburn
- Temperature
- Atrial fibrillation
- Hypotension
- Orthostatic hypotension
- orthopnea
- Pallor
- Paradoxical pulse
- Water retention
- Hiccup
- Drowsiness
- Sweating
- Tachycardia
- tachypnoea
- Cardiac tamponade
- Cough
- Pericardial effusion
- Pleural effusion
Further indications
The most common symptom of acute pericarditis is dull or acute, burning or oppressive chest pain. This sensation typically worsens in the supine position, during inhalation, with chest movement or with swallowing food; instead it can be relieved by sitting and leaning forward.
Pain may radiate from the precordial or retrosternal region to the neck, shoulders, left arm and back.
Other symptoms of pericarditis include asthenia, palpitations, tachypnea, dysphagia and hiccups. Furthermore, if pericarditis is caused by an infection, fever, chills and sweating may also occur.
When an accumulation of serous, blood or purulent fluid (pericardial effusion) forms between the two sheets of the pericardium, dyspnoea, cough and hypotension may occur up to cardiac tamponade, with hypotension, shock or pulmonary edema. Cardiac output can be greatly reduced and rhythm disturbances are possible.
Constrictive pericarditis typically causes fatigue, dyspnea, orthopnea, venous congestion, with peripheral edema, ascites, distension of the neck veins, hepatomegaly and pulmonary hypertension.
Diagnosis is based on symptoms, ECG changes and the presence of a pericardial fluid effusion on chest radiological examination or echocardiogram. At auscultation of the heart it is characteristic to feel a pericardial rubbing (the layers of the inflamed pericardium rub against each other during the heart beats). Moreover, in the presence of effusion, the cardiac tones are attenuated.
Depending on the suspected diagnosis, further assessments can be performed to identify the cause: blood tests, immunological and serological tests, pericardial fluid aspiration and pericardial biopsy. The ESR and PCR (inflammation rates) are often high.
Therapy depends on the cause and may include antibiotics or antifungals in bacterial or fungal infectious forms, painkillers and anti-inflammatory drugs. Some patients may be prescribed cortisone and diuretics. When the amount of pericardial effusion is important, drainage is performed through pericardiocentesis. In the case of chronic pericarditis, however, it may be necessary to resort to surgical removal of the pericardium (pericardiectomy).
