The pericardial disease or pericarditis appears when the pericardium is irritated and swollen. The pericardium is the thin salike membrane that surrounds the heart. When pericarditis appears, the patient experiences chest pains. Sometimes there are also other symptoms which are going to be detailed in this article. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other.
Most of the cases are mild and usually improve on their own. When the cases are more severe, medication is necessary and sometimes even surgery. Early diagnosis and treatment help a lot in reducing the risk of long-term complications.
Symptoms of Pericarditis
As mentioned above, pericarditis can be classified depending on the pattern of symptoms and how long they last. For instance, the symptoms of acute pericarditis last less than three weeks. On the other hand, incessant pericarditis lasts between four and six weeks, but it does not exceed three months. Moreover, it is continuous.
Pericarditis is described as recurrent if it occurs about four to six weeks after an episode of acute pericarditis with a symptom-free interval in between. Pericarditis is considered chronic if symptoms last longer than three months.
When you are dealing with acute pericarditis, the most frequent symptom is sharp, stabbing chest pain. The pain appears behind the breastbone or on the left side of the chest. Some people describe the chest pain as dull, varying in intensity, achy or pressure-like. The pain may also travel into the left shoulder and neck. In addition, it may intensity when you cough or inhale deeply. There are cases when the pain persists even when you sit up or lean forward. This is why sometimes it is difficult to make the difference between the pain that appears during a heart attack and the pericardial pain.
On the other hand, the pain caused by chronic pericarditis is associated with chest pain. Moreover, depending on the type, signs, and symptoms of pericarditis may include some or all of the following:
- Sharp, piercing chest pain over the center or left side of the chest. This pain is generally more intense when breathing
- Shortness of breath when reclining
- Heart palpitations
- Low-grade fever
- An overall sense of weakness, fatigue or feeling sick
- Abdominal or leg swelling
When you experience one of the symptoms above, it is very important to seek immediate medical care. Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. Therefore, the sooner you are evaluated, the sooner you can receive proper diagnosis and treatment.
What Can Cause Pericarditis?
In the case of a healthy person, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. When pericarditis occurs, the sac becomes inflamed. The resulting friction from the inflamed sac leads to chest pain.
However, the exact causes of pericarditis are not very easy to be determined. Usually, doctors either are unable to determine a cause (idiopathic) or suspect a viral infection. In some cases, pericarditis can also develop shortly after a major heart attack. This happens due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery.
Other causes of pericarditis include:
- Systemic inflammatory disorders. For example, lupus and rheumatoid arthritis.
- Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
- Other health disorders. These may include kidney failure, AIDS, tuberculosis, and cancer.
- Certain medications. Some medications can cause pericarditis, although this is unusual.
Complications of pericarditis may include the following:
- Constrictive pericarditis. Although these cases are uncommon, some people with pericarditis, usually those with long-term inflammation and chronic recurrences, can develop permanent thickening, scarring, and contraction of the pericardium. Therefore, the pericardium loses most of its elasticity. It starts to resemble a rigid case which is tight around the heart. This keeps the heart from working properly. This condition often leads to severe swelling of the legs and abdomen together with shortness of breath.
- Cardiac tamponade which appears when there is too much fluid collected in the pericardium. Excess fluid puts pressure on the heart and doesn’t allow it to fill properly. That means less blood leaves the heart, which causes a dramatic drop in blood pressure. Cardiac tamponade can be fatal if it isn’t promptly treated.
Diagnosis for Pericarditis
The first thing a doctor will do when diagnosing a patient with pericarditis is to ask about the medical history and more details about the chest pain and other symptoms. The doctor will also perform a physical exam and check the heart sounds using a stethoscope. This characteristic noise is called a pericardial rub.
The doctor may also ask for tests that can help determine whether you’ve had a heart attack, whether fluid has collected in the pericardial sac or whether there are signs of inflammation.
Some of the following procedures may be also necessary:
- Electrocardiogram (ECG). Certain ECG results may indicate pericarditis, while others could indicate a heart attack.
- Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart. Images of your heart may show an enlarged heart if excess fluid has accumulated in the pericardium.
- Echocardiogram. This test creates an image of your heart and its structures, including fluid accumulation in the pericardium. Your doctor can view and analyze this image on a monitor.
- Computerized tomography (CT) used to produce more-detailed images of your heart.It is very helpful to exclude other causes of acute chest pain, such as a blood clot in a lung artery (pulmonary embolus) or a tear in your aorta (aortic dissection). CT scanning can also be used to look for thickening of the pericardium that might indicate constrictive pericarditis.
- Cardiac magnetic resonance imaging (MRI). It creates cross-sectional images of your heart that can reveal thickening, inflammation or other changes in the pericardium.
Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed, including:
- Pain relievers which are available without a prescription, such as aspirin or ibuprofen. These medications also help lessen inflammation. Prescription-strength pain relievers also may be used.
- Colchicine reduces inflammation in the body. It can be prescribed for acute pericarditis or as a treatment for recurrent symptoms. It can reduce the length of pericarditis symptoms and decrease the risk that the condition will recur. However, the drug is not safe for people with certain pre-existing health problems, such as liver or kidney disease, and for those taking certain medications. Your doctor will carefully check your health history before prescribing colchicine.
- Corticosteroids. If you don’t respond to pain relievers or colchicine or if you have recurrent symptoms of pericarditis, your doctor may prescribe a steroid medication.