Pericarditis: Unraveling the inflammation of the heart's protective sac

January 26, 2019
Healthcaretoday, Dr G.S. Sridhar, Sri Kota Specialist Medical Centre, Pericarditis, Heart health, Cardiology, Chest pain, Viral infections, tuberculosis, heart disease, health awareness, Medical diagnosis, Cardiac care, chronic illness, autoimmune disorders, kidney failure, heart protection, Medical treatment,
Pericarditis is a medical condition characterized by inflammation of the pericardium, the double-layered sac that encases the heart. This structure serves crucial functions: it holds the heart in place and protects it from infections and malignancies. A small amount of fluid exists between the layers of the pericardium, reducing friction as the heart beats.

Causes of pericarditis
According to Dr. G.S. Sridhar (pix), a consultant cardiologist at Sri Kota Specialist Medical Centre, several factors can lead to pericarditis. The condition is most commonly observed in younger individuals, particularly females in their 20s and 30s. The primary culprits behind the inflammation often include:

Viral infections: These are the most frequent causes of pericarditis, with viruses like Coxsackievirus, influenza, and HIV being notable offenders.

Tuberculosis: This infectious disease can lead to pericardial inflammation, particularly in regions where TB is prevalent.

Kidney failure: Elevated urea levels in the blood due to kidney dysfunction can also trigger pericarditis.

Dr Sridhar explains that pericarditis can be categorized based on its duration:
  • Acute pericarditis: Symptoms last less than four to six weeks.
  • Incessant pericarditis: Symptoms persist for more than four to six weeks but less than three months despite treatment.
  • Chronic pericarditis: Symptoms last over three months.
  • Recurrent pericarditis: Occurs when pericarditis reappears after a symptom-free period of at least four weeks.

Symptoms of pericarditis
One of the hallmark symptoms of pericarditis is chest pain, which arises from the inflamed layers of the pericardium rubbing against the heart. This pain can manifest suddenly and is typically sharp and stabbing, located in the middle or left side of the chest. Patients may also experience referred pain in one or both shoulders.

Dr Sridhar notes, “Patients with pericarditis often describe a pricking pain in the center of the chest that worsens when lying flat but improves when sitting up.” This positional nature of the pain is a key differentiator from pain associated with heart attacks, which can be more diffuse and crushing.

Diagnosing pericarditis
The diagnosis of pericarditis involves a comprehensive clinical evaluation supported by various tests. Dr Sridhar outlines the diagnostic process:
  • Clinical examination: The physician listens for a characteristic friction rub, indicative of inflammation and fluid accumulation between the pericardium and the heart.
  • Blood tests: These help identify any underlying infections or inflammatory markers.
  • Electrocardiogram (ECG): An ECG may reveal concave ST elevations, a common finding in pericarditis.
  • Echocardiography: This ultrasound of the heart can detect fluid accumulation in the pericardial space.
  • Magnetic Resonance Imaging (MRI): An MRI may be utilized for further evaluation, especially in complicated cases.

Treatment options
The treatment of pericarditis is primarily directed at the underlying cause. If the inflammation is due to an infection, appropriate antiviral or antibiotic therapy is crucial. In many cases, the exact cause may remain unidentified, leading to a focus on symptomatic treatment. Dr Sridhar emphasizes that pain management is essential, often utilizing Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or high doses of aspirin to alleviate discomfort.

In more severe cases, additional interventions may be necessary, including corticosteroids to reduce inflammation or, in rare instances, surgical procedures to drain excess fluid from the pericardial space.

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