Pericarditis: Symptoms, Causes and Treatment

January 31, 2020
The symptoms of pericarditis are very similar to those of a heart attack. However, this problem resolves on its own and only requires common analgesics in most cases. It rarely requires further measures.

Pericarditis refers to the inflammation of the pericardium, a sac-shaped membrane that surrounds the heart. This membrane has two layers and between them and contains a small amount of liquid. This is a lubricant for the two layers to slide back and forth.

When the volume of the fluid increases in a person, they have pericarditis. This could clog the heart and impair its function. However, there are no major problems in most cases and it usually goes away without treatment. However, it’s important to note that the most serious cases do require medication and even surgery in some rare instances.

Pericarditis mainly affects men between the age of 20 and 50. There are cases that are impossible to treat and so a surgeon removes the pericardium. It doesn’t lead to serious consequences.

Types of pericarditis

A tissue sample.

There are two types of pericarditis: acute and chronic. Here are their characteristics:

  • Acute pericarditis has a sudden onset that lasts less than six weeks and, with relative frequency, leads to pericardial effusion. The symptoms are similar to those of a heart attack. Only a small percentage of patients have relapses.
  • Chronic pericarditis arises as a result of the thickening of the pericardium or an accumulation of fluid. It lasts more than six weeks and can lead to right ventricular failure. This is edema in the abdominal area, pretibial area, and ankles. Chronic pericarditis occurs when fibrous tissue forms around the heart, compresses it and increases the pressure in those veins that carry blood to it. Thus, the pericardium fluid stagnates and accumulates in other parts of the body on its way out.

Causes of pericarditis

It’s impossible to establish the cause of pericarditis in about 80% of the cases. However, it’s very common for its origin to be the result of some sort of infection. It’s very likely for it to be a viral infection. There may be a bacterial infection but to a lesser extent, and only very rarely it could be due to a fungal infection.

Likewise, there are many cases in which pericarditis appears along with any of the following diseases:

  • Autoimmune diseases
  • Cancer, including leukemia
  • AIDS
  • Renal insufficiency
  • Hypothyroidism
  • Tuberculosis
  • Rheumatic fever

In other cases, it’s the direct result of a heart attack or cardiac surgery or trauma to the thoracic area. Sometimes, pericarditis may come from inflammation of the myocardium, chest radiotherapy, or the use of certain drugs.

Symptoms and diagnosis

A comparison of a healthy vs sick heart.

Read also: Chest Pains: Why Do They Happen?

The typical symptom of acute pericarditis is very uncomfortable. It feels like a stabbing pain on the left side of the chest, behind the sternum. However, some experience only mild and constant pain. Other people report feeling pressure in the chest of varying intensity.

Many times, people also feel pain in their left shoulder and neck. The discomfort is typically more intense when they cough, inhale deeply or during bedtime. It gets better when they sit up and lean forward a bit.

Chest pain is usually the predominant symptom in cases of chronic pericarditis but there may be other acute symptoms such as:

You may be interested: Atrial Flutter: Symptoms and Causes

Treatment for pericarditis

The milder cases of pericarditis usually resolve on their own. However, once a doctor detects pericarditis, they’ll most likely prescribe a drug treatment. It usually consists of pain relievers that can manage the pain and reduce the inflammation.

Doctors might also prescribe Colchicine because it reduces inflammation and prevents recurrent episodes. However, this drug isn’t safe for those with liver or kidney disease or undergoing other drug treatments. Also, a doctor may prescribe corticosteroids if there’s no response to the aforementioned drugs. Also, if pericarditis is due to a bacterial infection, the physician will prescribe antibiotics.

In the most severe cases, especially if there’s suspicion of cardiac tamponade, the professional may drain the fluid via a pericardiocentesis procedure. Finally,  a pericardiectomy or definitive removal of the pericardium is seldom necessary.

  • Freixa, X. (2010). Evaluación, manejo y tratamiento de las pericarditis y miocarditis agudas en urgencias. Emergencias, 22(4).
  • Adlam, D., & Forfar, J. C. (2018). Pericardial disease. Medicine (United Kingdom). https://doi.org/10.1016/j.mpmed.2018.08.002
  • Rahman, A., & Saraswat, A. (2017). Pericarditis. Australian Family Physician.