Pericarditis

Overview  

Pericarditis is a medical condition where the pericardium, a thin sac enveloping the heart and filled with fluid, becomes inflamed. This inflammation causes sharp chest pain as the layers of the pericardium rub against each other. 

Pericarditis typically emerges abruptly and can persist for a period ranging from weeks to several months. It usually resolves within three months, although in some cases, recurrent episodes may occur over several years. Occasionally, there may be an accumulation of fluid between the layers of the pericardium, referred to as pericardial effusion. 

There are several types of pericarditis: 

• Acute pericarditis: This occurs when the pericardium, the protective membrane around the heart, becomes suddenly inflamed, leading to the rapid onset of symptoms. 
• Chronic pericarditis: In this type, the inflammation of the pericardium persists for three months or longer after the initial acute episode. 
• Constrictive pericarditis: This is a severe form of pericarditis where the inflamed layers of the pericardium stiffen, thicken, and develop scar tissue, causing them to stick together. Constrictive pericarditis disrupts the normal functioning of the heart. It often arises after multiple episodes of acute pericarditis over time. 
• Infectious pericarditis: This type of pericarditis occurs as a result of an infection caused by a virus, bacteria, fungus, or parasite. 
• Idiopathic pericarditis: Idiopathic pericarditis refers to cases where the cause of the inflammation is unknown. 
• Traumatic pericarditis: Traumatic pericarditis develops after an injury to the chest, such as those sustained in a car accident. 
• Uremic pericarditis: This type of pericarditis arises due to kidney failure. 
• Malignant pericarditis: Malignant pericarditis occurs when cancerous cells grow within the body and affect the pericardium. 

In cases of pericarditis that are more severe, treatment options often involve the use of medications and, in rare instances, surgical intervention. Early diagnosis and treatment may help reduce the risk of long–term complications from pericarditis. rewrite 

Symptoms  

Pericarditis pain typically manifests behind the sternum or towards the left side of the chest. The pain may exhibit the following characteristics: 

• Radiate to the left shoulder and neck. 
• Intensify during coughing, lying down, or deep breathing. 
• Alleviate when sitting up or leaning forward. 

Pericarditis can present with various signs and symptoms, which may include: 

• Dry cough 
• Back, neck, or left shoulder pain 
• Fatigue, weakness, feeling sick, or anxiety 
• Swelling in the legs 
• Low grade fever 
• Rapid or irregular heartbeat (heart palpitations) 
• Difficulty breathing while lying down 
• Severe cases may result in swelling of the legs, feet, and ankles. 

Pericarditis can present with different symptoms depending on its type. The categorization is based on the duration of symptoms and the pattern they follow: 

• Acute pericarditis: This type starts suddenly and typically lasts for up to three weeks. It’s possible for future episodes to occur. Distinguishing acute pericarditis from heart attack pain can sometimes be challenging. 
• Recurrent pericarditis: Following an episode of acute pericarditis, this type reoccurs approximately four to six weeks later, with no symptoms in between episodes. 
• Incessant pericarditis: Symptoms of incessant pericarditis are continuous and persist for about four to six weeks but less than three months. 
• Chronic constrictive pericarditis: This form develops gradually and lasts longer than three months. Its symptoms tend to persist over an extended period. 

If you notice any symptoms of acute pericarditis, it is essential to promptly contact your doctor. For immediate and urgent treatment, call emergency services and seek medical attention at the nearest hospital. 

Causes 

Pericarditis can be challenging to diagnose as its cause is often unknown, leading to idiopathic pericarditis. However, there are several potential causes that may contribute to the development of pericarditis, including: 

• Viral Infections: Pericarditis can be a complication of viral infections, such as gastrointestinal viruses or COVID–19, leading to viral pericarditis. 
• Bacterial Infections: Bacterial pericarditis can occur as a result of a bacterial infection, including tuberculosis. 
• Fungal Infections: Fungal pericarditis can be caused by an infection from fungi. 
• Parasitic Infections: Pericarditis can also be caused by an infection from parasites, resulting in parasitic pericarditis. 
• Immune System Response: The immune system’s reaction following heart damage caused by a heart attack or heart surgery is known as Dressler syndrome, which is also referred to as postmyocardial infarction syndrome or postcardiac injury syndrome. 
• Inflammatory Disorders: Conditions such as lupus and rheumatoid arthritis, which involve inflammation, can contribute to the development of pericarditis. 
• Chest Injuries: Traumatic pericarditis can occur as a result of chest injuries, such as those sustained in a car accident. 
• Chronic Health Conditions: Pericarditis can be associated with other chronic health conditions, including kidney failure and cancer. 
• Tumors: Certain tumors, such as lymphoma, can cause malignant pericarditis. 
• Genetic Diseases: Genetic disorders like Familial Mediterranean Fever (FMF) can increase the risk of developing pericarditis. 
• Medications: Although rare, pericarditis can be caused by medications that suppress the immune system.

Risk factors

There are several factors that can increase the risk of developing pericarditis, including: 

• Age: Pericarditis primarily affects individuals between the ages of 16 and 65 years old. 
• Gender: While anyone can develop pericarditis, males tend to experience it more frequently than females.
• Other underlying conditions: The risk of developing pericarditis is heightened in individuals who have experienced a heart attack, undergone open heart surgery (which can lead to postpericardiotomy syndrome), received radiation therapy, or undergone percutaneous procedures such as cardiac catheterization or radiofrequency ablation (RFA).