Inflammations of the heart: pericarditis

By Cristiano Antonino Last updated Jun 18, 2023

Pericarditis is the inflammation of the pericardium, the membrane that surrounds the heart, itself formed by two layers, an outer one called the fibrous pericardium and an inner one called the serous pericardium

They, divided by a thin layer of fluid, envelop and protect the heart by reducing friction with neighbouring organs, allowing the heart to dilate and contract freely.

When the pericardium becomes inflamed, there will be an increase in this fluid, which can limit the function of the heart pump, and we will speak of pericardial effusion.

We will speak of acute pericarditis if it lasts less than 6 weeks; acute pericarditis can be divided into fibrinous when there will be inflammation of the leaflets, production of fibrin and absence of fluid or scarcity.

It will be effusive when there is production of serous or haematic fluid.

We will speak of subacute pericarditis when it will last from 6 weeks to 6 months; we will speak of constrictive subacute pericarditis when there will be stiffening and thickening of the pericardium, a kind of inextensible constrictive membrane will be formed that causes the limitation of cardiac activity.

We will have subacute effusive-constrictive pericarditis when in addition to thickening and stiffening there will also be fluid effusion.

We will speak of chronic pericarditis when its manifestation persists for more than 6 months; it can be either constrictive or effusive.

It will be adhesive when the connective tissue obstructs the space between the pericardial sheets, giving rise to adhesions that do not allow correct and effective cardiac contraction.

What are the causes of pericarditis?

Establishing what causes pericarditis is not easy. The mechanisms behind the causes can be divided into infectious and non-infectious causes.

Some of the causes are infections of viral, bacterial or fungal origin, radiotherapy, chest trauma, immunodepressive drug treatments, autoimmune diseases such as rheumatoid arthritis, lupus, leukaemia, and tumours.

When it is not possible to recognise the triggering factors, it is called idiopathic pericarditis.

What are the symptoms of pericarditis?

In general, it is mostly men who are affected by pericarditis.

In some cases, pericarditis may be asymptomatic, most often presenting as pain in the chest, which may also reach the left arm, neck, back and in some cases the abdomen; it may be intense or mild.

The typical one is a dull, sharp pain that tends to worsen with inhalation, supine position, coughing or swallowing; it tends to ease when sitting or leaning forward.

Sometimes it may be accompanied by fever, tachycardia, cold sweating, difficulty breathing, fatigue, exhaustion, especially in cases where pericarditis is a consequence of an infection.

The tests to be performed to diagnose pericarditis are: the ‘classic’ electrocardiogram, to check for alterations in the heart’s electrical activity, present in more than half of all cases of pericarditis; chest X-ray; blood tests with particular attention to inflammatory indices; the transthoracic echocardiogram, which indicates pericardial inflammation if there is ‘reflectivity’ and when present, reveals the presence of pericardial effusion and in what quantity.

How is pericarditis treated?

If a specific cause can be found from the symptoms, it must be investigated with specific treatments.

In other cases, no investigation is carried out but non-steroidal anti-inflammatory drug treatment, especially acetylsalicylic acid and ibuprofen, will be given for several weeks, gradually reducing the doses. In some cases, colchicine will also be administered in order to reduce the risk of recurrence.

Symptoms will tend to subside within a couple of days.

If the non-steroidal anti-inflammatory treatment is not effective or has contraindications, corticosteroids will be prescribed; corticosteroids, however, may be associated with the risk of chronic evolution.

For colours that will require long-term therapy with high corticosteroid dosage, other therapies such as intravenous immunoglobulin may be administered.

It must be said, however, that pericarditis can vary from a mild disease that improves on its own and is not life-threatening, to becoming serious.

If treated promptly, in most cases with acute pericarditis, it tends to heal in a few weeks or within a few months, and there is usually no permanent damage to the heart and/or pericardium.

Preventing pericarditis is not possible.

With currently available therapies, the risk of recurrence can be reduced but not eliminated while keeping the probable underlying causes under control.

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