Pericarditis: Causes, Symptoms, and Treatment

Pericarditis is the inflammation of the pericardium, a double-layered membrane that surrounds and protects your heart. This inflammation can cause an increase in the amount of fluid that helps the heart move comfortably or cause the pericardium to harden. Although it usually occurs after a viral infection, it can rarely be seen as a result of heart attack, kidney failure, autoimmune diseases, or side effects of some medications. Sharp, stabbing chest pain is the most distinctive sign of pericarditis.

What is Pericarditis?

Pericarditis is the inflammation of the pericardium, a flexible and thin membrane that surrounds your heart. The pericardium surrounding your heart acts as a shield that protects your heart from external factors. Inflammation of the pericardium can lead to serious complications such as “tamponade” or “constrictive pericarditis” that cause your heart to compress inward and reduce its blood pumping ability.

Pericarditis can usually start as a mild discomfort and resolve spontaneously within a few weeks, or it can become chronic and take on a recurring state lasting for months. Therefore, as with every chest pain complaint, pericarditis symptoms should also be taken seriously.

What Causes Pericarditis?

The most common cause of pericarditis is viral infections. Viruses that cause common cold or respiratory tract infections can trigger a pericarditis attack. However, pericarditis can sometimes develop after heart attack, kidney failure, autoimmune diseases (such as rheumatoid arthritis, lupus), some traumas, or radiotherapy applied to the chest area. In most cases, the exact cause of pericarditis may not be fully determined, and this condition is called “idiopathic pericarditis.”

Let’s examine the main factors causing pericarditis in more detail:

Infections:

• Viral Infections: This is the most common cause. Viruses such as influenza (flu), HIV, and Coxsackie viruses are the most common triggers of pericarditis.
• Bacterial Infections: More rarely seen and usually occurs when bacterial infections from the lungs or elsewhere in the body spread to the pericardium.
• Fungal Infections: Can be seen in people with weakened immune systems.

Heart Diseases:

• Heart Attack: Damage to the heart muscle after a heart attack can cause inflammation of the pericardium. This condition is called Dressler Syndrome.
• Heart Surgery: There is a risk of developing pericarditis after heart operations.
• Autoimmune Diseases: Pericarditis can develop in diseases such as rheumatoid arthritis and lupus where the body attacks its own tissues.

Other Causes:

• Kidney Failure: In patients with chronic kidney failure, urea substance accumulated in the blood can lead to pericarditis formation.
• Trauma: Blows or injuries to the chest area can trigger pericarditis.
• Cancer: Cancers or metastases developing in organs close to the heart can be a cause of pericarditis.
• Medications: Pericarditis can be seen as a side effect of some medications.

What are the Symptoms of Pericarditis?

The most distinctive and most common symptom of pericarditis is chest pain. This pain is usually sharp, stabbing, or knife-like and can radiate to the left shoulder and neck. Its most important feature is that it changes with position: the pain relieves when you lean forward or sit up, while it worsens when you lie on your back or take a deep breath. In addition to chest pain, symptoms such as fever, fatigue, and cough can also accompany pericarditis.

Let’s examine the most common symptoms of pericarditis in detail:

• Chest Pain: Usually the main symptom of pericarditis. It can be confused with heart attack pain, but unlike heart attack, it changes with position, not with exertion.
• Fever: Especially in cases where pericarditis is infection-related, high fever can be seen.
• Fatigue and Weakness: Occurs due to the body fighting infection and strain on heart function.
• Cough: Pericarditis can cause coughing fits.
• Shortness of Breath: Shortness of breath can be felt due to pressure caused by increased pericardial fluid or chronic inflammation.
• Heart Palpitations: Palpitation sensation such as irregularity or increase in heart rate can be experienced.

Who Gets Pericarditis?

Although pericarditis is a condition that can be seen at any age and in any gender, it is usually more common in young adult men. Especially individuals who have had viral infections, have autoimmune diseases, suffer from kidney failure, or have recently undergone heart surgery are at higher risk for pericarditis. Being aware of these risk factors ensures that you take the situation seriously when symptoms appear.

How is Pericarditis Diagnosed?

Pericarditis diagnosis begins with careful listening to your symptoms and physical examination. While listening to your heart sounds, your doctor may hear the “friction rub” that is typical for pericarditis. Tests such as ECG, chest X-ray, blood tests, and echocardiogram are usually used to confirm the diagnosis. These tests allow us to evaluate both the presence of pericarditis and possible complications.

The main methods used in pericarditis diagnosis are:

• Physical Examination and History: Your doctor may hear the characteristic friction sound (friction rub) of pericarditis while listening to your heart sounds. Detailed information is obtained about when your symptoms started and in which positions they change.
• Electrocardiogram (ECG): In pericarditis, typical wave changes (ST segment elevation) are usually seen on ECG, but these changes are different from ECG findings in heart attack.
• Echocardiogram (Heart Ultrasound): Provides detailed images of your heart and pericardium. With this test, we can see the amount of pericardial fluid and possible impairments in your heart’s contractile movement.
• Blood Tests: Markers such as CRP and ESR that show the level of inflammation in the body are examined. Additionally, viral and bacterial tests can be performed to determine the cause of infection.
• Chest X-ray: If pericardial fluid accumulation is excessive, it shows the size of the heart shadow.

How is Pericarditis Treated?

Pericarditis treatment is determined according to the underlying cause and severity of the disease. Usually, medications aimed at reducing inflammation are used. While rest and painkillers may be sufficient for viral pericarditis, stronger anti-inflammatory medications such as colchicine and steroids may be used in more severe cases. In rare cases, a procedure called pericardiocentesis to drain accumulated fluid or surgical intervention may be required.

The methods applied in pericarditis treatment are:

Medication Treatment:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications such as aspirin or ibuprofen are used to reduce pain and inflammation.
• Colchicine: This is a very effective medication in pericarditis treatment and reduces the risk of disease recurrence.
• Corticosteroids: Used only when other medications are insufficient or when there is an underlying autoimmune disease.

Pericardiocentesis:

• Performed in cases called pericardial tamponade, where the heart is compressed due to excessive fluid accumulation in the pericardium.
• With the help of a thin needle or catheter, excess fluid is withdrawn from the pericardium, allowing the heart to relax.

Surgical Intervention:

• In cases of recurrent or chronic pericarditis, removal of part or all of the pericardium (pericardiectomy) may be required for conditions such as constrictive pericarditis.

What are the Risks and Complications of Pericarditis?

Although pericarditis is usually a mild condition that does not leave permanent damage, it can carry some serious risks and complications. The most important risks include pericardial effusion and pericardial tamponade. Pericardial tamponade occurs when fluid accumulated in the pericardium compresses your heart and creates a life-threatening situation. Chronic pericarditis can lead to hardening of the pericardium (constrictive pericarditis), permanently impairing your heart’s blood pumping ability.

It is important for you to know the potential risks and complications of pericarditis so that you take the situation seriously and take the necessary steps:

• Pericardial Effusion: Fluid accumulation within the pericardial membrane during pericarditis. While a small amount of fluid usually does not cause problems, excessive fluid accumulation can lead to serious problems.
• Pericardial Tamponade: This is the most dangerous complication of pericardial effusion. Rapidly accumulating fluid prevents your heart from contracting, lowering blood pressure and disrupting blood return to the heart. It requires emergency medical intervention.
• Constrictive Pericarditis: Chronic and recurrent pericarditis can cause the pericardium to harden and lose its flexibility. This condition can prevent your heart from contracting and relaxing normally, leading to heart failure symptoms.

What are the Ways to Prevent Pericarditis?

Although it is not always possible to directly prevent pericarditis, there are some steps you can take to reduce the risk. The most important prevention method is to protect against viral and bacterial infections. Therefore, it is important to pay attention to hand hygiene, avoid contact with sick people, and get vaccinations such as flu shots. Additionally, if you have an underlying autoimmune disease or kidney failure, not neglecting the treatment of these diseases reduces the risk of pericarditis.

What you can do to reduce pericarditis risk:

• Protection from Infections: You should be careful against viral infections. Measures such as regular hand washing, wearing masks in crowded environments, and flu vaccination can be beneficial.
• Control of Underlying Diseases: If you have chronic diseases such as diabetes, kidney failure, lupus, it is important to comply with treatment and keep your disease under control.
• Healthy Lifestyle: To keep your immune system strong, you should eat healthily, exercise regularly, and stay away from cigarettes.

When Should You See a Doctor?

If you are experiencing sharp, stabbing chest pain, this pain relieves when you lean forward and worsens when you lie on your back, you should consult a cardiology specialist without delay. Especially if chest pain is accompanied by fever, shortness of breath, or fatigue, this may be pericarditis or a more serious heart disease. You should not hesitate to go to the emergency room with chest pain complaints, because early diagnosis can save lives.

Frequently Asked Questions About Pericarditis

How long does it take for pericarditis to heal?

The healing time of pericarditis depends on its cause and response to treatment. Mild cases caused by viruses usually improve within a few weeks with rest and medications, while serious cases caused by bacterial or autoimmune causes can last for months and require additional treatments.

Can pericarditis recur?

Yes, pericarditis can become chronic or recurrent in some people. Especially autoimmune diseases or incompletely treated infections can cause this; in this case, long-term medication use may be required.

Does pericarditis occur in young people too?

Pericarditis can occur at any age. In young people, it usually develops after viral infections, and can be seen without an underlying serious disease and often has a benign course.

Is it safe to exercise during pericarditis?

Exercise is not recommended during acute pericarditis, because physical activity can increase the load on the heart and increase the risk of complications. After recovery is complete, light exercises can be started with doctor’s approval.

How is pericarditis distinguished from heart attack?

Pericarditis pain is usually sharp and position-dependent (for example, it decreases when leaning forward), while heart attack pain is more widespread, crushing, and can radiate to the arms. ECG and blood tests help clarify this distinction.

Does pericarditis completely resolve?

In mild cases, pericarditis can completely resolve with appropriate treatment and not leave a permanent problem. However, in serious cases, for example, if constrictive pericarditis develops, long-term effects on heart functions may remain.

Does pericarditis pose a risk during pregnancy?

Pericarditis is rare during pregnancy, but if it occurs, it can create additional difficulties for both mother and baby. Treatment is carefully planned and usually attempts to be controlled with medications.

Can the symptoms of pericarditis be confused with other diseases?

Symptoms such as chest pain and shortness of breath can be confused with lung diseases, reflux, or musculoskeletal problems. Therefore, imaging and specific tests are of great importance for diagnosis.

Is diet important during pericarditis?

Although a special diet is generally not required, reducing salt intake can help control fluid accumulation. Healthy nutrition can support immunity and accelerate recovery.

When can someone who has had pericarditis return to normal life?

Recovery time varies from person to person, but in mild cases, normal life can be resumed within a few weeks, and in serious cases, after treatment is completed and complications are resolved.

Is pericarditis a contagious disease?

Pericarditis is not contagious, but if it originates from viral or bacterial infections, these infections may have the potential to spread to others. However, pericarditis itself does not pass from person to person.

Reference: Pericarditis