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Pericarditis and pericardial disease

About
Risks
Symptoms
Diagnosis
Prevention

Pericarditis is an inflammation of the pericardium, the thin sac-like membrane that surrounds the heart. It can occur as an isolated condition or as part of a broader spectrum of pericardial disease, including pericardial effusion and constrictive pericarditis. The etiology can be infectious, autoimmune, or idiopathic, and the condition may lead to complications such as cardiac tamponade if not properly managed.

Common risk factors for pericarditis include viral infections, particularly from pathogens such as Coxsackie virus and influenza, autoimmune diseases like lupus and rheumatoid arthritis, and post-myocardial infarction syndrome. Additional risks may include past radiotherapy to the chest, chronic kidney disease, and certain medications. Lifestyle factors such as smoking and stress may also contribute, although their exact roles are less clear.

The hallmark symptom of pericarditis is sharp chest pain that may worsen with deep breathing or lying flat, often relieved by sitting forward. Patients may also experience fever, fatigue, and a pericardial rub upon auscultation. In cases of significant pericardial effusion, symptoms can include shortness of breath and a sensation of fullness in the chest as the fluid accumulation compresses the heart.

Pericarditis is primarily caused by viral infections, such as those caused by the influenza virus or enteroviruses, and can also result from bacterial infections, autoimmune diseases like lupus or rheumatoid arthritis, or after a heart attack. It may occur post-surgery, particularly after cardiac procedures, or be associated with other conditions like kidney failure or cancer. In some cases, the exact cause remains idiopathic, meaning it is unknown.

Diagnosis of pericarditis typically involves a combination of clinical evaluation, history taking, and diagnostic tests. Physical examination may reveal a characteristic pericardial friction rub, while an electrocardiogram (ECG) can demonstrate characteristic ST-segment elevations. Imaging studies such as echocardiography or chest X-ray can assess for pericardial effusion, and blood tests may be conducted to identify underlying inflammatory or infectious causes.

Treatment for pericarditis typically involves anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine, to alleviate pain and reduce inflammation. In more severe cases, corticosteroids may be prescribed, and if there is a significant fluid accumulation (pericardial effusion), a procedure to drain the fluid may be necessary. Addressing any underlying condition is also crucial to prevent recurrence.

While pericarditis cannot always be prevented, certain measures can mitigate the risk, particularly for those with known autoimmune conditions or a history of viral infections. Maintaining proper vaccination, such as against influenza, and effectively managing underlying health issues can also reduce the incidence. Additionally, avoiding excessive physical strain and practicing stress management techniques may contribute to overall cardiovascular health.
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