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Pericarditis (Inflamed Heart Lining)

The thin membrane surrounding the heart is called the pericardium. It is composed of two layers, the inner visceral pericardium which is attached to the outer surface of the heart and the outer parietal pericardium. In between the two layers is a small amount of pericardial fluid within a small cavity. The inflammation of the pericardium is known as pericarditis.

Pericarditis can be acute or chronic. Acute pericarditis can be caused due to infection or trauma which could be of a short duration. Chronic pericarditis develops gradually and could be result of any underlying disease such as uremia. Early diagnosis of pericarditis is important and can prevent the development of complications.

Symptoms of Pericarditis

Chest pain around the center of the chest, behind the breastbone, is the main symptom. It is of a sharp stabbing nature and usually aggravated with deep breathing, sneezing or coughing. The pain may be referred to the shoulder. The pain is aggravated when lying down and relieved by sitting up or bending forward.

Difficulty in breathing may be present if excessive amount of secretions are present within the pericardial space. There could also be a dry hacking cough, hoarseness of voice and difficulty in swallowing. Fever may be present. Joint pain, malaise and anorexia may be present. In severe cases, there could be leg swelling and ascites (collection of excessive fluid in the abdomen).

Causes of Pericarditis

Any part of the heart can become inflamed, which is broadly referred to as carditis. Often pericarditis occurs on its own but can occur with inflammation of other parts of the heart. There are many causes of pericardial inflammation. Sometimes cause is never determined in which case it is referred to as idiopathic pericarditis. Known causes include :

  • Rheumatic heart disease
  • Infective: Viral, bacterial, fungal or parasitic.
  • Metabolic diseases, such as uremia.
  • Collagen disorders, such as systemic lupus erythematous.
  • Post heart attack, due to tissue damage and spread of inflammation to the pericardium.
  • Postoperative – Dressler syndrome.
  • Cancerous growths of the pericardium, primary or secondary (spread of cancer from other parts of the body).
  • Trauma.
  • Endocrine disorders, such as myxoedema.
  • Drugs, such as hydralazine.
  • Other causes such as serum sickness and radiation exposure.

Treating Pericaditis

Diagnostic tests involve electrocardiogram (ECG), chest x-ray, echocardiogram, CT scan and MRI. ECG studies help evaluate an underlying heart attack if present. Pericarditis can also be indicated in ECG findings. The extent of effusion can be evaluated with the help of x-rays and a more detailed study can be done with a CT scan and MRI.

The approach to treating pericarditis largely depends on the type and case. Mild pericarditis may not need any treatment and may resolve on its own. Analgesics and antiinflammatory drugs are given to alleviate pain. Severe pain may need treatment with narcotic medications. Infections if present are treated with specific antibiotics. Corticosteroids may be given to prevent inflammation.

Marked fluid accumulation around the heart may lead to a complication called cardiac tamponade. There is inappropriate filling of the heart due to pressure caused by the fluid around the heart. This is a serous complications any usually requires hospitalization and drainage of pericardial fluid by pericardiocentesis. Removal of the pericardium may also be indicated in some severe and chronic cases.

 


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