Pericarditis

Pericarditis

Pericarditis means inflammation of the outer covering of the heart (pericardium). It can occur in an isolated fashion or along with inflammation of the inner layers of the heart (myocardium – heart muscle and endocardium – inner lining the heart and valves).

What conditions can cause pericarditis?

Inflammation can occur due to infections, injury or after a heart attack. Abnormal metabolites in the blood (waste products of metabolism) as in kidney failure can also cause pericarditis. Infections can be bacterial, viral or fungal. One of the important bacterial infections causing pericarditis is tuberculosis. When heart muscle is damaged by a heart attack, its outer covering can also be damaged. That is how pericarditis occurs after a heart attack. Pericarditis can occur in some generalised inflammatory diseases like rheumatoid arthritis and rheumatic fever which involves multiple joints of the body in addition to the heart. In some cases, it can be due to malignant diseases involving the pericardium.

What are the important symptoms of pericarditis?

Most important symptom of pericarditis is chest pain. It can increase on deep breathing and while swallowing. Unless it occurs as a complication of heart attack, the nature of pain is quite different from that of a heart attack. Sometimes shortness of breath can occur. If inflammation is severe enough to cause fluid collection within the two layers of pericardium, it may compress the heart and prevent proper filling. This can lead to a life threatening condition known as cardiac tamponade. This condition is more likely to occur in malignant diseases (cancer). Simple collection of fluid within the layers of the pericardium is known as pericardial effusion.

What treatment can be given for pericarditis?

When there is an underlying cause like bacterial or fungal infection, appropriate antibiotics can be given to treat the cause. When it is due to a generalized inflammatory disease like rheumatoid arthritis, treatment is the same as that of the basic condition. Simple viral infections are usually self limited and need only analgesics to relieve the pain. When there is a large collection of fluid compressing the heart, it has to be removed by immediate aspiration (pericardial aspiration) or by surgery (pericardial drainage). Surgical drainage is needed when the fluid is thick pus due to infections which cannot be easily aspirated. If it is due to tuberculosis, appropriate period of anti tuberculosis medications is needed, even if fluid is removed by aspiration.