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Pericarditis – Causes, Symptoms and Treatment

Pericarditis is an inflammation of the pericardium, the protective sac surrounding the heart. It typically causes sharp chest pain and is most often treatable with anti-inflammatory medications.

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Things worth knowing about "Pericarditis"

Pericarditis is an inflammation of the pericardium, the protective sac surrounding the heart. It typically causes sharp chest pain and is most often treatable with anti-inflammatory medications.

What is Pericarditis?

Pericarditis is an inflammation of the pericardium, the thin, two-layered, fluid-filled sac that surrounds and protects the heart. Under normal conditions, a small amount of fluid between the two layers reduces friction as the heart beats. When this tissue becomes inflamed, the condition is called pericarditis. It can be classified as acute (sudden onset), recurrent (repeat episodes), or chronic (lasting more than three months).

Causes

Pericarditis can result from a variety of causes:

Viral infections: The most common cause, including viruses such as Coxsackievirus, adenovirus, and Epstein-Barr virus.
Bacterial infections: Less common but more serious, including tuberculosis.
Autoimmune diseases: Conditions such as systemic lupus erythematosus or rheumatoid arthritis.
Heart attack: A reactive pericarditis (Dressler syndrome) can develop weeks after a myocardial infarction.
Trauma or surgery: Chest injuries or cardiac surgery may trigger inflammation of the pericardium.
Medications: Certain drugs (e.g., hydralazine, procainamide) may rarely cause pericarditis.
Cancer: Metastatic tumors can involve the pericardium.
Idiopathic: In many cases, no specific cause is identified.

Symptoms

The hallmark symptom of pericarditis is a sharp or stabbing chest pain, which typically worsens when lying flat or breathing deeply, and improves when sitting upright or leaning forward. Additional symptoms may include:

Fever and general malaise
Shortness of breath (dyspnea)
Heart palpitations or irregular heartbeat
Fatigue and weakness
Difficulty swallowing (in cases of significant pericardial effusion)

In severe cases, fluid can accumulate between the pericardial layers, a condition known as a pericardial effusion. If this fluid accumulation compresses the heart and impairs its function, a life-threatening condition called cardiac tamponade may occur, requiring immediate medical intervention.

Diagnosis

Several diagnostic methods are used to confirm pericarditis:

Medical history and physical examination: A characteristic pericardial friction rub may be heard through a stethoscope.
ECG (Electrocardiogram): May show typical changes such as widespread ST-segment elevation.
Echocardiography: Ultrasound imaging of the heart to detect pericardial effusion.
Blood tests: Elevated inflammatory markers (CRP, ESR) and troponin levels to assess potential myocardial involvement.
Cardiac MRI: Provides detailed images of pericardial inflammation in complex cases.
Chest X-ray: May show an enlarged cardiac silhouette in cases with significant effusion.

Treatment

Treatment depends on the underlying cause and the severity of the condition:

Medications

NSAIDs (Non-steroidal anti-inflammatory drugs): Ibuprofen or aspirin are the first-line treatment to relieve pain and reduce inflammation.
Colchicine: Recommended in combination with NSAIDs to prevent recurrence and speed recovery.
Corticosteroids: Used when standard therapy fails or in autoimmune-related cases, though they may increase the risk of recurrence.
Antibiotics: Prescribed when a bacterial infection is confirmed.

General Measures

Physical rest and avoidance of strenuous exercise until full recovery
Treatment of the underlying condition in secondary pericarditis

Invasive Procedures

Pericardiocentesis: Needle drainage of accumulated pericardial fluid in cases of large effusion or cardiac tamponade.
Pericardiectomy: Surgical removal of the pericardium in chronic constrictive pericarditis.

Outlook and Prognosis

Most cases of acute pericarditis resolve completely within a few weeks with appropriate treatment. However, approximately 15–30% of patients experience a recurrence. Chronic constrictive pericarditis, in which the pericardium becomes scarred and thickened, is less common but more serious and may require surgery. Regular follow-up care is important to detect and manage potential complications early.

References

Adler, Y. et al. – 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, 36(42), 2921–2964. DOI: 10.1093/eurheartj/ehv318.
Imazio, M. & Gaita, F. – Diagnosis and treatment of pericarditis. Heart, 101(14), 1159–1168 (2015).
Kasper, D. L. et al. – Harrison's Principles of Internal Medicine, 20th edition. McGraw-Hill Education, 2018.

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