The pericardium is a two-layered membrane that surrounds the heart like a sac. It contains a small amount of fluid that helps reduce friction between the layers as the heart beats. Pericarditis occurs when this pericardium becomes inflamed. In some cases, an excess of pericardial fluid accumulates between the layers, which is known as pericardial effusion. This inflammation can affect heart function and cause pain.
Symptoms of pericarditis
The most common symptom of pericarditis is a sharp pain in the chest, usually behind the sternum or on the left side of the chest. This pain often worsens when taking a deep breath, lying down, or coughing, and may improve when sitting and leaning forward. There may be other symptoms that are usually related to the underlying cause or to the severity of pericarditis, such as:
Fever.
Chills.
Weakness or fatigue.
Dry cough.
Difficulty breathing, especially when lying down.
Swelling in the legs or abdomen.
Palpitations (irregular heartbeats).
It is important to note that the severity and presentation of symptoms can vary significantly from person to person. Some people may experience mild symptoms, while others may have more severe symptoms.
Classification of pericarditis
Pericarditis is classified according to its duration and the presence or absence of fluid in the pericardium.
According to duration:
Acute pericarditis: it is characterized by a sudden onset of symptoms and a duration of less than 2 months. A common example is viral pericarditis.
Recurrent pericarditis: it involves the recurrence of pericarditis after a symptom-free period (after 4-6 weeks without symptoms). This recurrence can occur several times and can be as severe as the initial episode.
Chronic pericarditis: it persists for more than three months, often with fluctuating symptoms. Autoimmune pericarditis can manifest as chronic pericarditis.
According to the presence of pericardial fluid:
Dry (fibrinous) pericarditis: it is characterized by inflammation of the pericardium without a significant accumulation of fluid. It is the most common form of pericarditis.
Pericardial effusion: it involves the accumulation of fluid between the layers of the pericardium. This fluid can be serous (clear), hemorrhagic (with blood), or purulent (with pus).
Causes and risk factors of pericarditis
In many cases, the cause of pericarditis is unknown, but it is often believed to be caused by a viral infection.
Some factors may increase the likelihood of developing pericarditis. It is important to remember that the presence of these factors does not guarantee that pericarditis will develop, but it does increase the possibility. Risk factors for pericarditis include:
Recent viral infections.
Autoimmune disorders.
Chest injuries.
History of pericarditis.
Radiotherapy in the chest.
Some medications can trigger an inflammatory reaction in the pericardium.
While pericarditis is usually a benign condition, in some cases it can lead to serious complications, such as:
Severe pericardial effusion: large accumulation of fluid in the pericardium can compress the heart and impair its function.
Cardiac tamponade: it is a life-threatening condition in which fluid buildup in the pericardium puts pressure on the heart, preventing it from filling with blood properly.
Constrictive pericarditis: it is a rare complication in which the pericardium thickens and becomes rigid, restricting the heart’s ability to expand and fill with blood.
It is essential to seek medical attention if pericarditis is suspected, as early diagnosis and treatment can help prevent these complications. en ayudar a prevenir estas complicaciones.
Diagnosis of pericarditis
The diagnosis of pericarditis involves a complete clinical evaluation and tests, which include:
Clinical evaluation: the doctor will review the patient’s medical history and perform a physical examination, paying special attention to heart and lung sounds.
Electrocardiogram (ECG): this test records the electrical activity of the heart and can show changes characteristic of pericarditis.
Chest X-ray: this test can help rule out other conditions, such as pneumonia or a collapsed lung, and may show an enlarged heart if there is a large pericardial effusion.
Echocardiogram: this test uses sound waves to create images of the heart to check its function and detects the presence of fluid in the pericardium.
Blood tests: blood tests can be performed to detect signs of inflammation, such as an elevated white blood cell count or elevated C-reactive protein, and to rule out other causes of chest pain, such as a heart attack.
Cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI): in some cases, these imaging tests can be performed to obtain a more detailed view of the heart and pericardium.
Treatments for pericarditis
The treatment plan for pericarditis is tailored to the individual needs of each patient, taking into account the underlying cause, the severity of the symptoms, and the presence of any complications. Treatment options include:
Rest: rest is essential during the acute phase of pericarditis to allow the pericardium to heal. It is recommended to limit intense physical activity until symptoms have subsided, and blood test markers have returned to normal.
Pharmacological treatment: treatment of pericarditis usually includes the administration of medications such as olchicine. The use of corticosteroids is reserved for specific indications and should be used at the lowest effective dose.
Pericardiocentesis: pericardiocentesis is a procedure to drain/evacuate excess fluid from the pericardium in which a needle is inserted into the pericardial sac. This procedure is performed under image guidance, such as echocardiography, to ensure safety and accuracy. At HM Hospitales, our cardiology specialists are highly trained in performing pericardiocentesis.
Pericardiectomy: in rare cases of constrictive pericarditis, a pericardiectomy may be required. This surgical procedure involves the removal of part or all of the thickened and scarred pericardium that restricts the movement of the heart.
In some cases, a multidisciplinary approach may be required for the treatment of pericarditis. This may involve cardiologists, infectious disease specialists, rheumatologists, and cardiac surgeons, depending on the underlying cause and complications of pericarditis.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have pericarditis, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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