Pericarditis

Illustration of normal heart and pericardium versus heart with pericarditis

Figure A shows the location of the heart and a normal heart and pericardium (the sac surrounding the heart). The inset image is an enlarged cross-section of the pericardium that shows its two layers of tissue and the fluid between the layers. Figure B shows the heart with pericarditis. The inset image is an enlarged cross-section that shows the inflamed and thickened layers of the pericardium.

Image is in the Public Domain. Created and uploaded on 12 November 2013.

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Patient Advice

Definition

Pericarditis is inflammation of the thin sac (pericardium) surrounding the heart. This can cause chest pain and may lead to fluid buildup around the heart.

Aetiology

Causes of pericarditis include:

  • Unknown (Idiopathic): Most cases have no clear cause.
  • Infections: Viral infections (e.g., Coxsackievirus), bacterial infections (e.g., tuberculosis), or fungal infections.
  • Autoimmune conditions: Conditions where the body attacks itself, such as lupus.
  • Heart injury: Inflammation after a heart attack or surgery.
  • Kidney failure: Build-up of toxins due to poor kidney function (uraemia).
  • Cancer: Spread of cancer to the pericardium.
  • Medications: Certain drugs like hydralazine or isoniazid.

Pathophysiology

Pericarditis occurs when the pericardium becomes irritated or inflamed. This can cause:

  • Fluid Build-up: Extra fluid (effusion) in the sac can press on the heart.
  • Scar Formation: Long-term inflammation may lead to stiffening of the sac, making it harder for the heart to work.

Risk Factors

Risk factors include:

  • Recent viral or bacterial infections.
  • Autoimmune diseases like lupus.
  • Kidney failure.
  • Heart surgery or injury.
  • Use of certain medications.

Signs and Symptoms

Key symptoms are:

  • Chest Pain: Sharp, worsens when lying flat, improves when sitting forward.
  • Shortness of Breath: Especially when lying down.
  • Fever: Common in infections.
  • Heart Sounds: A scratching noise (pericardial friction rub) heard through a stethoscope.

Investigations

To diagnose pericarditis, the following tests are used:

  • Blood Tests:
    • CRP and ESR: These markers are raised due to inflammation.
    • Troponin: May be elevated if the heart muscle is also inflamed (myopericarditis).
    • Blood Cultures: To identify bacterial infections if fever is present.
    • Kidney Function Tests: To check for uraemia, which can cause pericarditis.
  • ECG (Electrocardiogram): A test showing patterns like widespread ST elevation or PR depression, typical in pericarditis.
  • Echocardiography: An ultrasound scan of the heart to check for fluid build-up or signs of pressure on the heart.
  • Chest X-ray: May show an enlarged heart if fluid is present around it.
  • CT or MRI: Advanced imaging to detect thickening, scarring, or constriction of the sac in chronic cases.

Management

1. First-Line Treatment

  • Anti-inflammatory medication: Ibuprofen (600 mg three times daily) for 1–2 weeks to reduce inflammation and pain.
  • Colchicine: Taken for 3 months (e.g., 0.5 mg twice daily) to lower the chance of recurrence.

2. Escalation of Care

  • Corticosteroids: Prednisolone (1 mg/kg daily) is used in autoimmune or resistant cases but must be tapered gradually.
  • Pericardiocentesis: A procedure to drain fluid from around the heart using a needle under ultrasound guidance. This is done if there is fluid causing pressure on the heart (tamponade).

3. Specialist Referral

In cases where symptoms persist or complications arise, refer to a specialist (e.g., cardiologist) for:

  • Further imaging (e.g., MRI) to confirm diagnosis.
  • Consideration of surgical removal of the pericardium (pericardiectomy) if constrictive pericarditis develops.

Patient Advice

Advice for patients includes:

  • Avoid strenuous physical activity until symptoms fully resolve.
  • Take all prescribed medications as directed and complete the full course.
  • Seek medical advice if symptoms worsen, such as increasing chest pain or difficulty breathing.
  • Attend follow-up appointments to ensure full recovery.

References

  1. National Institute for Health and Care Excellence (NICE) (2024). Pericarditis: Diagnosis and Management. Available at: https://www.nice.org.uk (Accessed: 30 December 2024).
  2. British Heart Foundation (BHF) (2024). Pericarditis Overview. Available at: https://www.bhf.org.uk (Accessed: 30 December 2024).
  3. Wikipedia contributors (n.d.). Pericarditis. Retrieved from: https://en.wikipedia.org/wiki/Pericarditis (Accessed: 30 December 2024).
 
CardiologymypanotesPericarditis