Pericarditis is a medical condition characterized by inflammation of the pericardium, the thin, double-layered sac surrounding the heart. This inflammation can lead to chest pain and other symptoms, ranging from mild discomfort to severe complications. Understanding the causes, symptoms, diagnosis, treatment, and potential complications of pericarditis is essential for effective management and improved outcomes. In this comprehensive overview, we will explore pericarditis in detail.

Anatomy and Function of the Pericardium:

The pericardium consists of two layers:

1. Fibrous Pericardium: The outer layer, composed of tough, fibrous tissue, provides structural support and anchors the heart within the chest cavity.
2. Serous Pericardium: The inner layer consists of two sublayers: the parietal pericardium (which lines the fibrous pericardium) and the visceral pericardium (also known as the epicardium, which covers the heart’s surface). Between these layers is a small amount of fluid, the pericardial fluid, which lubricates the surfaces, allowing smooth movement of the heart during contractions.

Causes of Pericarditis:

Pericarditis can be caused by various factors, including:

1. Viral Infections: Most cases of acute pericarditis are viral in origin, commonly caused by enteroviruses (e.g., coxsackievirus) or other respiratory viruses.
2. Bacterial Infections: Bacterial pericarditis is less common but can occur as a complication of untreated bacterial infections elsewhere in the body or as a result of direct spread from nearby structures.
3. Autoimmune Conditions: Pericarditis can be associated with autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and inflammatory bowel disease.
4. Post-Myocardial Infarction (Dressler Syndrome): Pericarditis may develop as a complication of a heart attack (myocardial infarction), typically several weeks to months after the acute event.
5. Trauma: Blunt chest trauma, such as a motor vehicle accident or a fall, can cause inflammation of the pericardium.
6. Radiation Therapy: Radiation treatment for chest malignancies may lead to pericarditis as a late complication.
7. Idiopathic: In some cases, the cause of pericarditis remains unknown (idiopathic).

Symptoms of Pericarditis:

The hallmark symptom of pericarditis is chest pain, which may vary in intensity and character. Other common symptoms include:

1. Sharp, stabbing chest pain: Typically worsens with deep breathing, coughing, or lying flat and improves when sitting up or leaning forward. The pain may radiate to the neck, shoulders, or back.
2. Fever and chills: Especially in cases of infectious pericarditis.
3. Pericardial friction rub: A scratchy or grating sound heard on auscultation (listening with a stethoscope) over the precordial area (the front of the chest where the heart is located).
4. Dyspnea (shortness of breath): Particularly with exertion or when lying flat (orthopnea).
5. Palpitations: Awareness of abnormal heartbeats or irregular rhythm.
6. Fatigue and weakness: Due to the strain on the heart and systemic effects of inflammation.

Diagnosis of Pericarditis:

The diagnosis of pericarditis is based on a combination of clinical evaluation, medical history, physical examination, and diagnostic tests. Key steps in the diagnostic process include:

1. Medical History and Physical Examination: The healthcare provider will inquire about symptoms and perform a thorough physical examination, including listening for a pericardial friction rub.
2. Electrocardiogram (ECG or EKG): An ECG can reveal characteristic changes, such as diffuse ST-segment elevations and PR-segment depressions, suggestive of pericarditis.
3. Chest X-ray: Although typically normal in pericarditis, a chest X-ray may help rule out other causes of chest pain or identify complications such as pericardial effusion.
4. Laboratory Tests: Blood tests may be ordered to assess markers of inflammation (e.g., C-reactive protein, erythrocyte sedimentation rate) and to screen for infectious or autoimmune causes.
5. Echocardiography: This imaging test uses sound waves to visualize the heart and pericardium. It can detect pericardial effusion and assess cardiac function.

Treatment of Pericarditis:

The management of pericarditis aims to relieve symptoms, reduce inflammation, and prevent complications. Treatment strategies may include:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen, aspirin, or other NSAIDs are commonly used to reduce pain and inflammation.
2. Colchicine: This medication may be added to NSAIDs for acute pericarditis to prevent recurrences.
3. Corticosteroids: In cases of severe or refractory pericarditis, corticosteroids (e.g., prednisone) may be prescribed to suppress inflammation.
4. Pericardiocentesis: If pericardial effusion is causing significant hemodynamic compromise or cardiac tamponade, a procedure called pericardiocentesis may be performed to drain excess fluid from the pericardial sac.
5. Treatment of Underlying Cause: Depending on the etiology, specific treatments may be initiated, such as antiviral medications for viral pericarditis or antibiotics for bacterial pericarditis.

Complications of Pericarditis:

While most cases of pericarditis resolve with appropriate treatment, complications can occur, including:

1. Pericardial Effusion: Accumulation of fluid in the pericardial sac, which may lead to cardiac tamponade if the fluid exerts pressure on the heart chambers, impairing cardiac function.
2. Constrictive Pericarditis: Chronic inflammation can cause scarring and thickening of the pericardium, leading to impaired cardiac filling and restrictive physiology.
3. Recurrent Pericarditis: Some individuals may experience recurrent episodes of pericarditis, requiring long-term management and close follow-up.

Prognosis:

The prognosis for pericarditis is generally favorable with appropriate treatment. Most cases of acute pericarditis resolve within a few weeks to months, with symptom relief and resolution of inflammation. Recurrences are possible, especially in cases of idiopathic or viral pericarditis. Constrictive pericarditis and cardiac tamponade are rare but serious complications that require prompt recognition and intervention. Long-term outcomes depend on the underlying cause, the presence of complications, and adherence to treatment and follow-up recommendations.

Prevention:

Preventing pericarditis involves addressing underlying risk factors and avoiding triggers when possible. Strategies for prevention may include:

1. Vaccination: Getting vaccinated against preventable viral infections, such as influenza and varicella, may reduce the risk of viral pericarditis.
2. Prompt Treatment: Early diagnosis and treatment of infections and autoimmune diseases may help prevent secondary pericarditis.
3. Trauma Prevention: Taking precautions to prevent blunt chest trauma, such as wearing seat belts and protective gear during activities with a risk of injury.
4. Monitoring: Close monitoring and follow-up for individuals at risk of recurrent pericarditis, with adjustments to treatment as needed.