Pericarditis

The irritation and swelling of pericardium which is the thin sac-like membrane surrounding your heart is called pericarditis.

Chest pain is the often cause of this disease along with other symptoms.

When the irritated layers of the pericardium rub against each other, the sharp chest pain associated with pericarditis occurs. It will suddenly begin but will not last long (acute).

It is considered chronic pericarditis if the symptoms develop gradually or persist.

Most of the cases are just mild and will improve on their own but treatments for severe cases include medication and sometimes surgery.

To help reduce the risk of long term complications form pericarditis, you may undergo early diagnosis and treatment.

The symptoms of pericarditis vary depending on its type.

In acute pericarditis, mostly it will last for a few weeks but in chronic recurrent pericarditis that has two types:

• incessant type that will occur within six weeks of having medical treatment for an acute episode;
• and intermittent type that occurs after six weeks.

The most common symptom is a sharp, stabbing chest pain in the left side of your chest or behind the breastbone in acute pericarditis but some people’s symptom for acute pericarditis, their chest pain is achy, pressure-like and dull with varying intensity.

The pain of acute pericarditis sometimes intensifies when you lie down, cough or inhale deeply and it may travel into your neck and left shoulder but sometimes it may be difficult to identify if it is a heart attack or pericardial pain with regards to the pain.

Chronic pericarditis might result in fluid around the heart (pericardial effusion) and is mostly related with chronic inflammation.

Chest pain is the common symptom of chronic pericarditis. Some of the signs, symptoms and types of pericarditis include:

• heart palpitations,
• shortness of breath when reclining,
• sharp, piercing chest pain on the left or the center of the chest,
• cough,
• lo-grade fever,
• leg or abdominal swelling and an overall sense of weakness,
• feeling sick or fatigue.

Some of the symptoms of pericarditis are similar to the symptoms of lung and heart conditions like the chest pain from pericarditis, it might be because of another problem such as blood clot in the lungs (pulmonary embolus) or heart attack.

It is hard to determine the cause of pericarditis, doctors may sometimes suspect a viral infection or will not determine the cause (idiopathic).

In a normal state, there is a small amount of lubricating fluid in the two-layered pericardial sac that surrounds your heart. If you have pericarditis, the sac is inflamed and the friction from it will lead to chest pain.

After a major heart attack, pericarditis can develop because of the irritation of the underlying damage in the muscle of the heart. Weeks after a heart attack or heart surgery, a delayed form of pericarditis may occur and it is called Dressler’s syndrome.

A mistaken inflammatory response by the body to its own tissue (autoimmune response – the heart and pericardium) is what the experts believe to be the cause of Dressler’s syndrome. Some of the cause of pericarditis include:

• trauma – injury to your chest or heart as a result of accidents;
• systemic inflammatory disorders – rheumatoid arthritis and lupus;
• certain medications;
• other health disorders – AIDS, kidney failure, cancer and tubercolosis.

Making a diagnosis of pericarditis is done by performing several tests.

Upon visiting your physician, he may recommend you to a cardiologist which specializes in heart conditions.

Ask a family member or a friend to accompany you in your visit. Bring a notebook and in it you can write down the symptoms that you are experiencing and for how long. You can also write down the vitamins, supplements and medications that you are taking and if you had recent health problems.

Some of the questions that you can ask your doctor include:

• What is causing my symptoms?
• What tests I am going to do?
• What treatments are available?
• Do I need to be hospitalized?
• What are the possible side effects of these treatments?
• Will I have a long-term complication?
• Do I need any restrictions?
• I have this other condition, how can I manage them both?

Your doctor will ask you some questions such as:

• What are the symptoms that you are having?
• Can you describe the symptoms?
• How severs is the pain?
• Are they gradually or suddenly?
• Have you ever experienced this in the past?
• Do you have breathing problems?
• Have you lost weight?
• Do you have a family history of heart disease?
• Do you smoke?

Your doctor will ask you about your chest pain, other symptoms and your medical history. He will conduct a physical exam and will listen to your heart sounds using stethoscope. He will check for sounds that are associated with pericarditis that are made when the pericardial layers rub against each other, this noise is called pericardial rub.

Your will undergo tests to determine if there are signs of inflammation, if you had a heart attack or if fluid has collected in the pericardial sac. He may also recommend blood test to check for bacterial or other infections that might be present.

Some of the diagnostic procedures include:

• Electrocardiogram (ECG) – electrodes will be attached to our skin to measure the electrical impulses given off your heart, as waves displayed on a monitor, impulses will be recorded;
• Echocardiogram – the sound waves that is used will create an image of your heart including fluid accumulation in the pericardium and this can be seen in a monitor;
• Chest X-ray – your doctor can study your heart’s size and shape and will show if there is enlargement  if there is an excess fluid in the pericardium;
• Computerized tomography (CT) scan -  your doctor will see a more detailed images of your heart and the pericardium. Your doctor will see if there are other causes of your chest pain such as a tear in your aorta (aortic dissection) or blood clot in a lung artery (pulmonary embolus) and to check for constrictive pericarditis which is the thickening of the pericardium;
• Cardiac magnetic resonance imaging (MRI) – the doctor can see if there is inflammation, thickening or other changes in the pericardium because this uses magnetic field and radio waves to create cross-sectional images of your heart.

The treatment of pericarditis will depend on the severity or cause of it.

Treatments of pericarditis include:

• Medications – for reduce of the swelling and inflammation such as over the counter pain relievers like aspirin or ibuprofen (Advil, Motrin IB), to lessen the pain and inflammation and might improve within a day of using these.
• Another medication is Colchicine (Colcrys) – to reduce symptoms like inflammation but is not safe for the use of the people with other conditions like kidney or heart disease.
• Corticosteroids – a steroid medication like prednisone. It will last within a few weeks in acute pericarditis but some will have a recurrence after the original episode. If there is a bacterial infection, you will be treated with antibiotiocs or even drainage;

Another treatment for pericarditis aside from medication is surgery. A dangerous complication due to fluid buildup around your heart is called cardiac tamponade and you will undergo a procedure pericardiocentesis or your doctor will recommend removing your pericardium (pericardiectomy) if it is severe and recurrent pericarditis.

In pericardiocentesis, your doctor will give you a local anesthetic and then a small tube (catheter) or a sterile needle will be used to remove and at the same time drain the excess fluid from the pericardial cavity, the drainage will go through for several days and this is done with ultrasound and echocardiogram. In pericardietomy, this is done to remove the whole pericardium that is making it hard for your heart to pump and that has become rigid.

Pericarditis cannot be prevented but you can take steps to reduce the risk of you having pericarditis such as:

• having a good hygiene,
• getting ongoing medical care,
• keeping up with your immunizations,
• regularly exercising,
• eating a balance and nutritious meals.

Some of the common homeopathic remedies for pericarditis include:

• Aconite for sudden and sharp pains,
• Cactus grandiflorus for palpitations,
• and Spongia tosta for anxiety and sweating.

These remedies should be done under a homeopathic professional.

Lifestyle modifications are necessary in order to cope with pericarditis.

Over the counter pain medications and rest is all that you need for mild cases in pericarditis.

Avoid rough activities for it may trigger the symptoms for pericarditis.

Consult your doctor as to how long are you going to do this.

Complications of pericarditis include:

Constrictive pericarditis

This is the scarring, contraction and thickening of the pericardium due to long term inflammation and chronic recurrences, this can also lead to shortness of breath and severe swelling of the abdomen and legs because the pericardium loses elasticity that keeps the heart from working properly;

Cardiac tamponade

When there is a lot of fluid in the pericardium that will put pressure on the heart that leads to low blood pressure and this can be life-threatening. To avoid long-term complications, consult your doctor immediately for diagnosis and treatment.