Pericarditis in children: peculiarities and differences from that of adults
Pericarditis is an inflammation of the heart’s lining sheets, causing chest pain, often intense. It is almost always resolved by administering anti-inflammatory drugs
Pericarditis is a condition characterised by inflammation of the pericardium, the membrane lining the heart
This is made up of 2 sheets separated by a very thin space, in which a very small amount of fluid is always collected, which performs a lubricating function and ensures that the movement of the heart does not cause friction.
In the event of inflammation, the fluid contained in this space increases in volume, causing chest pain and, very rarely, hindering normal cardiac function.
Causes of pericarditis
The cause of pericarditis is often unknown, so in most cases it is referred to as ‘idiopathic’.
Sometimes, however, it is caused by an infection, usually viral (this is called ‘viral pericarditis’).
In some cases, the initial stimulus is cardiac surgery in which the pericardium is opened (pericardiotomy), in which case it is called post-pericardiotomy syndrome.
In other cases, pericarditis is caused by trauma to the chest and, in still other cases, by inflammatory or autoimmune diseases such as Systemic Lupus Erythematosus or recurrent pericarditis.
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Symptoms of pericarditis in children
The inflammation can present as a single episode, which occurs most frequently, but can also recur with 2 or more episodes (recurrent pericarditis).
Symptoms of acute pericarditis are:
- Chest pain
- Weakness (asthenia)
- Fever
- Difficulty breathing
- Heart palpitations
- Irregularity of heartbeat
- Persistent wheezing cough (rarely).
The chest pain is usually localised behind the sternum (retrosternal pain), worsens with breathing and sometimes prevents lying down.
Painful symptoms tend to improve with sitting.
Sometimes the pain, which starts in the chest, may also extend posteriorly and be felt in the back or shoulder.
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Pericarditis in children: diagnosis
The diagnosis of acute pericarditis in children is made when at least 2 of the following criteria are present:
- Thoracic pericardial pain (retrosternal, very intense, sometimes constrictive pain, whose intensity increases with respiratory acts);
- Pericardial rubbing (noises heard by the physician on auscultation of the heart);
- Presence of pericardial effusion on echocardiogram.
An increase in C-reactive protein (CRP) in the blood, a typical manifestation of ongoing inflammation, confirms the inflammatory nature of the effusion.
Electrocardiogram (ECG) abnormalities may also be associated.
Treatment
Treatment includes the use of non-steroidal anti-inflammatory drugs (NSAIDs, e.g. high-dose Ibuprofen), Colchicine, glucocorticoids (cortisone) and biological drugs (immunomodulators: Anakinra).
The European Society of Cardiology has established guidelines for the treatment of acute pericarditis in adults.
To date, there are no similar guidelines for children.
However, even in paediatric age, the drugs of first choice are NSAIDs and colchicine, also in combination.
In patients who do not respond to conventional therapies and in whom an inflammatory component is clearly recognisable, for some years now Anakinra, an inhibitor of interleukin-1, a molecule that plays a very important role in inflammation, has been used.
Glucocorticoids, on the other hand, are to be considered in the event of failure or only partial response to the previously indicated drugs.
Prevention of pericarditis in children
It is not possible to prevent pericarditis. The therapies currently available, if properly applied, can reduce but not eliminate the risk of relapse in recurrent forms.
Clinical trials are underway to investigate whether the preventive use of anti-inflammatory drugs (e.g. Colchicine) prior to cardiac surgery requiring the opening of the pericardium may reduce the risk of post-pericardiotomy pericarditis.
Prognosis
The prognosis for pericarditis in children is good: patients and their families can be reassured about the nature of the condition and its likely course.
The potentially serious complication is cardiac tamponade: a very large effusion that can obstruct normal filling of the heart.
This is very rare and is associated with a significant acceleration of the heartbeat (tachycardia) and a marked reduction in blood pressure (hypotension).
In this case, it is necessary to empty the pericardium through a pericardial catheter or (more rarely) through cardiac surgery.
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