Pericarditis: What Is, Types, Causes, Symptoms, and Treatment

Pericarditis is usually mild and does not require treatment. Less commonly, it may lead to severe chest pain, fever, fatigue, and difficulty swallowing. These cases can be resolved with medications, including NSAIDs and corticosteroids. Surgeries are the last line of defense against pericarditis and are not performed commonly.

Types of Pericarditis

Types of pericarditis are classified based on the cause and the time symptoms are present. The four types that consider the cause include:

• Infectious pericarditis: The cause of this type is a virus, bacteria, fungi, or parasite.
• Uremic pericarditis: Kidney failure may lead to uremic pericarditis.
• Malignant pericarditis: This type develops due to cancer growing in the body.
• Traumatic pericarditis: This type occurs due to physical injury to the chest.

The other four types of pericarditis are based on how long the symptoms persist and include the following:

• Acute pericarditis: Acute pericarditis lasts no longer than six weeks. The chest pain usually develops suddenly and may be accompanied by other symptoms.
• Incessant pericarditis: This type of pericarditis lasts longer than six weeks.
• Chronic pericarditis: Chronic pericarditis is pericarditis that lasts longer than three months. Symptoms of this type may result in complications and affect the functioning of the heart.
• Recurring pericarditis: Recurring or refractory pericarditis occurs in 30% of cases. It refers to pericarditis that comes back after four to six weeks without symptoms.

Another type of pericarditis that is not included in these two groups is constrictive pericarditis. It’s a severe form of this condition that heavily affects heart performance. It occurs when the inflamed layers of pericardium thicken, stick together, stiffen, or develop a scar on the tissue. It may develop due to several instances of acute pericarditis.

Causes

Unidentified causes of pericarditis account for 90% of all cases. Doctors refer to such causes as idiopathic (unknown). Although it is difficult to tell the cause in a specific case, researchers identified many potential culprits behind pericarditis. These include the following:

• COVID-19
• Bacterial, fungal, and parasitic infections
• Injuries to the chest or heart
• Immune response to heart damage
• Genetic diseases include Familial Mediterranean fever (FMF)
• Autoimmune diseases

Unfortunately, if you are diagnosed with pericarditis, your condition is likely to be labeled as idiopathic pericarditis.

Risk Factors

Anyone can develop pericarditis regardless of age and health. However, some factors may increase the risk of this condition. These include:

• Being a male
• Being 16-65 years old
• Certain medications, including medications used to treat seizures, blood clots, and irregular heartbeats
• Having heart surgery or radiation therapy in the past
• Human immunodeficiency virus (HIV)
• Cancers
• Tuberculosis
• Kidney failure
• Experiencing traumatic accident, particularly blunt damage to the chest

Signs And Symptoms

According to the European Society of Cardiology, the characteristic symptom of pericarditis is pain in the chest, which is a complaint for 85 to 90% of all cases. The pain is often described as stabbing or sharp and gets worse while taking deep breaths, swallowing, coughing, and lying down. For many people, it improves when leaning forward or sitting.

All symptoms usually associated with pericarditis are as follows:

• Rapid heart rate
• Sharp or stabbing pain in the chest
• Difficulty swallowing
• Frequent hiccups
• Feeling that you are about to faint
• Pain in the chest that gets worse while breathing in or lying down
• Water retention
• Heart palpitations
• Swelling in the feet and legs
• Coughing
• Fatigue
• Anxiety
• Fever
• Swelling of the abdomen

For some people, chest pain may feel like a heart attack. However, there are some key differences between pericarditis and heart attack. For instance, heart attack is caused by a lack of blood flow, while pericarditis occurs due to inflammation, injuries to the chest, and infections.

If you experience the above symptoms, contact your healthcare provider immediately. Early diagnosis and treatment significantly lower the risk of severe pericarditis and possible complications.

Complications

Late diagnosis and poor management of pericarditis increase the risk of complications. These conditions include:

• Cardiac tamponade: Cardiac tamponade is a dangerous condition that occurs due to pressure on the heart caused by fluid buildup. As a result, less blood leaves the heart, which causes a significant drop in blood pressure. Cardiac tamponade requires immediate medical attention.
• Constrictive pericarditis: More commonly known as thickening and scarring of the heart lining, Constrictive pericarditis is a condition that may develop due to long-term pericarditis. It prevents the heart from filling correctly, leading to shortness of breath and swelling of the abdomen and legs.
• Pericardial effusion: Pericardial effusion refers to a fluid buildup around the heart. It’s another complication that may prevent the heart from pumping correctly.

Related Conditions

Pericarditis can co-occur or occur as a result of some health conditions. The most common ones include the following:

• Systemic lupus erythematosus
• Fibromyalgia
• Rheumatoid arthritis
• Hypertension (high blood pressure)
• Diabetes mellitus
• Chronic kidney disease

These conditions increase the risk of developing pericarditis, but it is essential to remember that this condition is not necessarily tied to other health problems. People who don’t have any of these conditions may also develop pericarditis at some point in their lives.

Diagnosis And Tests

Doctors usually diagnose pericarditis using a variety of tests and screenings, such as CT scan, MRI, X-ray, ECG, and blood test. Before your healthcare provider decides which exam would work best, they will perform a physical exam and ask about your symptoms first. Reviewing the patient’s medical history is vital to diagnosing pericarditis.

Here are the most common tests your doctor may order you to determine if you have pericarditis:

• Stethoscope examination: A stethoscope is a diagnostic device used to listen to the internal sounds of a patient’s body. It is typically used to evaluate sounds produced by the heart by placing the device on a chest. If you have pericarditis, your doctor will be able to hear a sound referred to as pericardial rub that occurs when inflamed pericardium lining rubs against each other.
• Cardiac computerized tomography (CT) scan: Cardiac CT scan is a test that uses X-rays to produce images of the chest and heart. It’s a useful diagnostic tool to determine the presence of heart thickening, which is a sign of constrictive pericarditis.
• Cardiac magnetic resonance imaging (MRI): Cardiac MRI is a test that uses radio waves and magnetic field to reveal the thickening or compression of the heart, pericardial inflammation, and extra fluid in pericardium.
• Blood tests: Blood tests usually accompany other tests for pericarditis to find the signs of a heart attack, infection, or inflammation. They also test the pericardium’s fluid and heart’s performance. People affected by pericarditis usually have ultra-sensitive C reactive protein levels and sedimentation rate (ESR) higher than optimal.
• Chest X-ray: Chest X-ray can show the size of the heart, fluid in the lungs, and changes in the heart’s shape.
• Electrocardiogram (ECG): ECG or EKG test can show the changes in a heart’s rhythm. It records electrical signals that are produced during a heartbeat and displays them on a computer screen as waves. About half of people with pericarditis have characteristic changes in heartbeat that an electrocardiogram can reveal. Some patients, however, don’t have any irregularities in heart rhythm.
• Echocardiogram: Echocardiogram evaluates the performance of a heart and determines whether there is a fluid around it. It creates images of a heart by using sound waves (ultrasound).

Conventional Treatment

Treatment methods for pericarditis deped on the underlying cause, type of pericarditis, and severity of symptoms. Cases that require treatment are usually resolved thanks to anti-inflammatory medication. If a bacteria caused pericarditis, it needs to be treated with antibiotics.

The good news is that most cases are mild and do not require any medicines. Rest and occasional use of pain relievers are all that is needed to recover from mild pericarditis. In other cases, your healthcare provider may reccomend these treatment options:

• NSAIDs: Nonsteroidal anti-inflammatory drugs are over-the-counter anti-inflammatory drugs your doctor may prescribe. Examples of NSAIDs include Ibuprofen and Aspirin, medicines which can quickly reduce a mild pain.
• Corticosteroids: Corticosteroids are medicines that help overcome inflammation. Your doctor may prescribe you this strong medicine if you have severe symptoms or if other medicines does not work.

Surgeries

Surgeries are a reccomended response to recurrent pericarditis that does not improve despite the use if medicines which is typically caused by a fluid build-up around the heart. The two following procedures are used to remove the excess fluid:

• Pericardiocentesis: In pericardiocentesis, a surgeon removes the fluid from pericardial cavity using a catherer (a small tube) or a needle.
• Removal of the pericardium (pericardiectomy): This procedure is performed in some cases of constrictive pericarditis that caused stiff and inflamed pericardium.

When Should You Seek Emergency?

You should seek an immediate medical care after experiencing the following symptoms:

• Chest pain that spreads to jaw, arms, back, and neck
• Severe chest pain that lasts longer than 15 minutes
• Diffculty breathing or shortness of breath
• Feeling as if you are about to faint

The above health issues may indicate a severe pericarditis but also a heart attack. Call emergency as soon as you notice the mentioned symptoms.

Prognosis for Pericarditis Patients

Pericarditis may take several weeks to resolve. Typically, acute pericarditis goes away on its own and does not develop again. Medicines, including NSAIDs and pain relievers, and resting, are sufficient treatment strategies to resolve mild cases.

Treatments for recurring and severe pericarditis are also available. However, it may take several months to fully recover from more serious cases.

How to Prevent Pericarditis?

There are no specific guidelines on how to avoid pericarditis, but certain behaviors and lifestyle choices lower the risk of developing this condition. Here are some general practices that can make you less likely to develop pericarditis:

• Some of the most significant risks for cardiovascular conditions, including pericarditis, are alcohol and tobacco. Quitting smoking and limiting alcohol intake contribute to overall heart health.
• Since infectious pericarditis can result from viral, bacterial, fungal, or parasitic infections, practicing good hygiene is essential. It involves regular handwashing, avoiding close contact with individuals who are sick, and staying up-to-date with vaccinations.
• Taking precautions to prevent traumatic injuries to the chest can lower the risk of developing traumatic pericarditis. These include wearing seat belts in vehicles, using protective gear during activities with a risk of chest injury, and following safety guidelines.
• Engaging in regular physical activity is essential for cardiovascular health. Exercise helps maintain a healthy weight, promotes good circulation, and strengthens the heart. Aim for at least 150 minutes of moderate-intensity exercise per week, as recommended by doctors.

Pericarditis – Key Facts You Should Know

Pericarditis is characterized by inflammation and swelling of the pericardium, the thin double-layered sac surrounding the heart. While most cases are mild, pericarditis can lead to severe symptoms such as sharp chest pain, fever, fatigue, difficulty swallowing, and rapid heart rate.

Types of pericarditis are categorized by their causes and duration. Infectious pericarditis results from infections, while uremic pericarditis is linked to kidney failure. Malignant pericarditis is associated with cancer, and traumatic pericarditis stems from chest injuries. Duration-wise, acute pericarditis lasts up to six weeks, while chronic pericarditis persists for over three months. Constrictive pericarditis, a severe form, occurs when inflammation leads to thickening and scarring.

Identifying the cause of pericarditis is challenging, with 90% of cases labeled idiopathic. Potential culprits include infections, heart injuries, genetic factors, autoimmune diseases, and even COVID-19. Risk factors include age, gender, certain medications, heart surgeries, HIV, cancers, tuberculosis, kidney failure, and chest trauma.

Several tests are used to diagnose pericarditis. These include stethoscope examinations, CT scans, MRIs, X-rays, ECGs, and blood tests. Treatment depends on the underlying cause, with NSAIDs and corticosteroids being the most common strategy. Surgeries, such as pericardiocentesis and pericardiectomy, are reserved for severe and recurrent cases with fluid buildup.

Sources

• British Heart Foundation. (2022). Pericarditis.
  https://www.bhf.org.uk/informationsupport/conditions/pericarditis#:~:text=Pericarditis%20is%20inflammation%20of%20the,most%20people%20recover%20within%20weeks
• American Heart Association. (2021). What is Pericarditis?
  https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
• NIH. (2023). Pericarditis.
  https://www.ncbi.nlm.nih.gov/books/NBK431080/
• NIH. (2020). Acute pericarditis: Update on diagnosis and management.
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964178/
• MedlinePlus. (2022). Pericarditis.
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