Pericarditis

Pericarditis is inflammation of pericardium; a fibrous sac filled by a small amout of fluid surrounding the heart. The symptoms of pericarditis include sharp stabbing chest pain, usually worse on breathing in and lying down. Pericarditis is a relatively common cardiac disease. 5% of all patients presenting to casualty with chest pain have pericarditis. Men are more prone to pericarditis than women. Pericarditis can occur in all age groups but more common in adults and in the elderly.

The pericardium

Pericardium is a double layered sac. The layers are separated by a small amount of viscous fluid. Pericarium works as a shock absorber to protect heart from injury and variation in the blood pressure, pericardial fluid acts as a lubricant to minimize friction during cardiac contraction and relaxation, and finally it functions as an anchor keeping the heart fixed in appropriate position inside the chest. Due to its role in protecting the heart, even a mild inflammation can cause considerable chest dyscomfort mimicking a heart attack.

Types of pericarditis

Pericarditis can be divided into three types: acute, recurring and chronic.

Acute pericarditis

Symptoms last less than three months and usually improve within a week or so. Most cases of acute pericarditis are due to viral infection but in 90% of patients the exact origin is not found and these cases are then called idiopathic pericarditis.

Recurring pericarditis

Approximately a quarter of people with acute pericarditis may develop recurring pericarditis. There is no clear reason of recurring pericarditis. It may be due to immune system reaction triggered by previous infection.

Chronic pericarditis

Chronic pericarditis lasts more than 3 months and can be due to bacterial infection such as tuberculosis. If advanced, it may lead to heart failure and require surgical intervention.

Prognosis

Non-steroidal anti-inflammatory (NSAIDS) drugs are the treatment of choice for acute pericarditis. In some patients a significant amount of fluid accumulates in the pericardial space and interferes with heart’s pumping function. This complication of pericarditis is called tamponade, is diagnosed by echocardiography and requires urgent drain to remove the fluid (pericardiocentesis). Colchicine is used to treat recurring pericarditis as it prevents the symptoms from returning. The treatment of chronic pericarditis depends upon the main cause. Sometimes medication is sufficient while some cases may need surgery.