The heart is located in the center of the chest and is surrounded by an outer tunic called pericardium. This coat has two layers, one that fully surrounds the heart muscle and a flexible layer surrounding the first layer of the pericardium. The pericardium tissue inflammation is a potentially serious condition and is called pericarditis.
There are many causes that can cause pericarditis, but most often the cause of the disease is unknown. Among the known causes of pericarditis the most common are:
• mechanical damage to the heart – heart attack (myocardial infarction), Dressler syndrome, surgery, postpericardiotomic syndrome and various types of trauma;
• bacterial infections – viral, fungal or HIV;
• cancer – primary (in rare cases) or metastatic;
• connective tissue diseases – rheumatoid arthritis, systemic lupus; erythematosus, sarcoidosis orscleroderma;
• metabolic diseases – uremia (kidney failure) or hypothyroidism;
• reactions to drugs – side effects of some medications can cause an immune response that causes inflammation of the pericardial sac. Medicines that may influence the development of pericarditis include feniotonina, hidralizina and procainamide.
Chest pains are the most common symptoms of pericarditis:
• pain is most often sharp (stabbing);
• pain can occur gradually or suddenly and can radiate to the back, neck or shoulders;
• if membrane irritation is involved, the pain may radiate to the shoulder blades;
• pain may get worse when the patient breathe deeply;
• pain is always positional and gets worse when the affected person is in the horizontal position. In most cases, the pain is relieved when the patient bends forward.
These characteristics of pain can help your doctor distinguish between pericardial inflammation and angina (condition that causes pain by narrowing of blood vessels).
Because the heart is located in the mediastinum, some symptoms depend on where the inflammation is:
• patient may experience shortness of breath due to pain, if the inflammation is located in the pericardium which is located near the lungs;
• pain during swallowing can occur if the inflammation is near the esophagus.
Other symptoms depend on the specific cause of the pericarditis. For example, infections can cause fever, chills, and other nonspecific manifestations such as muscle aches and malaise.
First, the doctor will do a physical assessment. He will assess:
• intensity of the pain
• pain model and the circumstances in which it occurs
• what improves the pain
• how is the chest pain (sudden or gradual) and what other symptoms are present.
Medical history can help your doctor determine more easily if there is another possible cause of chest pain present. The most common finding when doing a physical examination, which confirmed the diagnosis of pericarditis is almost always pericardial friction. Inflammation of the pericardial fluid present produces a noise that can be heard with a stethoscope. The sound is sometimes heard better when the patient bends forward (position that causes the heart to move to the front of the chest).
Other tests that can help diagnose pericarditis include:
• electrocardiogram – in pericarditis, there are often anomalies that can help diagnosis. Unfortunately, many normal variants can mimic changes that occur with pericarditis.
• radiographs – imaging test used to detect cardiac tissue expansion and exclusion of other conditions that can cause chest pain.
• ultrasound echocardiography – help detect fluid in the pericardial sac, although in mild cases of acute pericarditis, the fluid does not appear on echocardiography.
• blood tests – are recommended to detect some cases of pericarditis, including infections, leukemia , kidney failure, connective tissue disease or thyroid abnormalities.
Drugs that reduce inflammation are the first choice treatment. Inflammatory drugs such as ibuprofen, are used to reduce inflammation and the amount of fluid in the pericardial sac. Occasionally, the doctor will prescribe strong painkillers. In recurrent cases (especially when there is immune-mediated cause), corticosteroids can be extremely effective.Treating the root cause of pericarditis is essential and will be done depending on the severity of the disease.
Another treatment option is pericardiocentesis. This is a procedure that involves inserting a thin needle through the chest wall directly into the pericardial sac to drain some fluid.
In severe or recurrent cases, the patient may need either pericardiotomia (the doctor will cut a hole in the pericardial sac) or pericardectomia (complete removal of the pericardial sac).
Complications of pericarditis
- Cardiac tamponade. When there is a large amount of fluid in the pericardial sac, there may be a sharp pressure on the heart, preventing it from working properly. This is a medical emergency and must be treated as such. These symptoms tend to be nonspecific but may include shortness of breath and problems of daily exercise.
- Constrictive pericarditis. If the heart or pericardial sac is injured as a result of trauma or disease affecting the area, there may be space deficiencies. These deficiencies can aggravate the heart activity space to expand to collect blood from the body. Bleeding into the pericardium, due to trauma or surgery is the most common cause of constrictive pericarditis.