Pericarditis refers to the inflammation of the pericardium, the protective sac surrounding the heart. With appropriate medical care, adequate rest, and prescribed treatment, the condition typically shows improvement. 

In some situations, the symptoms may require drainage of fluids in the pericardial cavity. It may take several weeks or months to heal, even though in most cases, patients are fully recovered.

For NEET PG preparation, you must gain a clear knowledge of the symptoms, causes, diagnostic methods, and treatment strategies of pericarditis. It is essential for precise diagnosis and effective management of pericarditis, especially in critical care scenarios.

Keep reading for detailed insight! 

What is Pericarditis? 

Pericarditis is the inflammation of the pericardium, the fluid-filled two-fold shell surrounding the outward surface of the heart. This is usually a sudden condition, and patients may take a couple of weeks to a period of many months for recovery. In most instances, it resolves within three months.

Nevertheless, recurring episodes may continue intermittently over several years. In certain cases, an accumulation of fluid occurs between the two pericardial layers, a condition known as pericardial effusion.

What are the Different Types of Pericarditis?

Pericarditis can be classified into the following categories:

1. Chronic Pericarditis

It is characterised by long-term inflammation that continues for 3 months or more following an initial acute episode.

2. Acute Pericarditis

This type emerges rapidly and is marked by the abrupt appearance of symptoms due to inflammation of the pericardium.

3. Uremic Pericarditis

Linked to kidney failure, where toxins that are normally removed by the kidneys lead to inflammation of the pericardium.

4. Malignant Pericarditis

Caused by cancerous growths that affect the pericardium, malignant pericarditis often originates from a primary tumour elsewhere in the body.

5. Constrictive Pericarditis

A serious form in which the pericardial layers become rigid, thicken, adhere to each other, and may form scar tissue. This condition can disrupt normal cardiac function and often follows repeated episodes of acute inflammation.

6. Traumatic Pericarditis

It occurs due to chest injuries, such as those sustained in road traffic accidents or blunt trauma.

7. Infectious Pericarditis

Arises from an infection caused by viruses, bacteria, fungi, or parasites.

8. Idiopathic Pericarditis

It refers to cases where no specific underlying cause can be identified.

What are the Symptoms of Pericarditis?

The pericarditis symptoms are as follows:

1. Chest Pain: This may present as a sharp, stabbing discomfort or a pressure-like sensation. Pain typically occurs behind the breastbone or on the left side of the chest and may radiate to the neck or left shoulder.
2. Mild Fever: A slight increase in body temperature can signal ongoing inflammation.
3. Persistent Cough: A dry, nagging cough may occur in conjunction with chest pain or discomfort.
4. Fatigue: A common symptom, often presenting as overall weakness or a lack of energy.
5. Heart Palpitations: The condition may cause the heart to beat irregularly or more rapidly than usual.
6. Swelling: Fluid build-up may lead to noticeable swelling in the abdomen or legs.
7. Breathlessness: Difficulty breathing may become more noticeable when lying flat, due to pressure from inflammation or fluid buildup.

What are the Causes of Pericarditis? 

The following are some causes of pericarditis symptoms:

• Infections

Viral infections are the leading cause of pericarditis. Common illnesses such as cold, flu, or COVID-19 can provoke an immune reaction that inflames the pericardium. Bacterial, fungal, and parasitic infections can also lead to this condition, though less frequently.

• Autoimmune Diseases

Disorders involving abnormal immune responses can cause inflammation that extends to the heart. Notable examples include lupus, rheumatoid arthritis, Sjögren’s syndrome, sarcoidosis, and scleroderma. On rare occasions, inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis are also linked to pericarditis.

• Underlying Medical Conditions

Pericarditis has been linked to various medical conditions that affect heart or immune system function. These include heart attacks, chronic kidney disease, HIV/AIDS, tuberculosis, and specific types of cancer.

• Chest Trauma or Surgery

Pericarditis can arise within a period of days to months following major procedures like open-heart surgery or traumatic injuries to the chest. Incidents such as road traffic accidents, falls from bicycles, or sports-related injuries may contribute to the onset of this condition.

• Medications

Some medications that alter immune system function may lead to inflammation of the pericardium as an adverse effect.

What are the Risk Factors of Pericarditis?

While pericarditis can occur at any age, several factors may increase the risk of its occurrence. They include: 

• Lifestyle Influences

Excessive alcohol consumption and the use of stimulants such as amphetamines, cocaine, or intravenous drugs can impair both cardiovascular and immune system function, thereby increasing the risk of inflammation around the heart.

• Genetic Factors

Genetic makeup plays a significant role in how the body regulates inflammation. Individuals with certain genetic traits may be more predisposed to recurrent or idiopathic pericarditis due to heightened inflammatory responses.

• Age and Biological Sex

Pericarditis most commonly affects adolescents and adults between the ages of 16 and 65, with a higher incidence observed in males.

• Inherited Disorders

Some rare inherited conditions that affect the body’s inflammatory regulation system can elevate the risk of pericarditis. These include:

1. Familial Mediterranean fever
2. Tumour necrosis factor receptor-associated periodic syndrome (TRAPS)

How to Diagnose Pericarditis?

Diagnosing pericarditis involves a range of investigations to confirm the condition or rule out other possible causes presenting with similar symptoms. The following tests are commonly performed:

• Blood Tests

They are done to identify signs of inflammation, infection, or damage to the heart. An increase in the level of certain proteins can suggest either active inflammation or a recent heart attack.

• Electrocardiogram (ECG) 

This is a non-invasive method of recording the electrical activity of the heart. Electrodes are put on the chest and sometimes on the limbs, which are connected to a monitor which displays or prints the result. ECG may assist in discovering pericarditis by altering the pattern of the ECG.

• Chest X-ray

A chest X-ray helps assess the size and shape of the heart. An enlarged heart silhouette may suggest fluid accumulation or other complications.

• Echocardiogram 

This ultrasound-based test uses sound waves to produce real-time images of the heart in motion. It evaluates heart function and can detect fluid buildup around the heart, as well as whether the pericardium is affecting cardiac filling or output.

• Cardiac CT Scan

It is a type of diagnosis that involves the use of X-rays to produce accurate cross-sectional images of the heart and other associated structures. Cardiac CT scan is especially valuable in the detection of the thickening of the pericardium, which is characteristic of constrictive pericarditis.

• Cardiac MRI

Magnetic resonance imaging provides high-resolution pictures of the heart by the use of magnetic fields and radiation. It is able to show the evidence of inflammation, thickening, or any other abnormality in the layers of the pericardium.

What are the Treatment Options for Pericarditis?

Treatment of pericarditis is based on the severity and the cause of the condition. The mild ones usually clear off on their own, whereas the other severe or recurrent cases might require medical (surgical) decisions.

Here is a detailed overview:

1. Medication-Based Management

Pain relievers with anti-inflammatory properties are frequently recommended to alleviate discomfort and minimise inflammation. They may include:

• Antibiotics: It may be advised if a bacterial infection is identified as the underlying cause of the condition. In other cases, doctors may need to drain the fluid along with antibiotic treatment.
• Colchicine: Frequently prescribed to decrease inflammation and reduce the risk of symptom recurrence, especially in acute or recurrent pericarditis. It may interact with other medications, so prior medical history is reviewed before use.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs such as ibuprofen or aspirin are typically used to control discomfort and inflammation.
• Corticosteroids: Due to their powerful anti-inflammatory potential, corticosteroids such as prednisone can be used when the first-line medications fail or when the symptoms recur quite often.  

2. Surgical and Procedural Interventions

Surgery might be required in some instances, particularly where fluid has settled around the heart or where there is chronic constriction. Procedures may include:

• Pericardiocentesis: This is a less invasive technique where a needle or catheter is used to drain excess fluid from the pericardial space.
• Pericardiectomy: If the pericardium becomes abnormally thick or rigid, surgical removal may be required to restore normal heart function.

FAQs About Pericarditis 

1. Is pericarditis a serious condition?

The mild cases are likely to heal spontaneously, but the severe or repeated cases might influence the functioning of the heart, leading to medical or surgical treatment. Prevention of complications by early diagnosis and treatment of the underlying conditions is crucial.

2. How is pericarditis diagnosed?

The condition is normally diagnosed through a physical examination, blood test, ECG, chest X-rays, echocardiogram, cardiac CT, or MRI. These assist in identifying the presence of inflammatory fluid or heart malfunction.

3. Who is at a greater risk of developing pericarditis?

Young and middle-aged adults, especially males, are more commonly affected. Additional risk factors include a history of autoimmune disease, recent chest trauma or surgery, and certain genetic conditions.

Conclusion

Gaining a solid understanding of pericarditis, its symptoms, causes, diagnostic procedures, and treatment strategies is essential for both medical study and clinical application. Preventing complications and achieving improved patient outcomes is essential, and the key to prevention is early detection and effective management.

This topic entails clinical decision-making and will enable you as an NEET PG aspirant to treat critical cardiac conditions confidently. DocTutorials offers the best learning resource with high-yield lectures in video format, evidence-based notes, expert sessions, and more.
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