Pericarditis can affect anyone, regardless of age or gender. It can be acute (short-term) or chronic (long-lasting) and can have a variety of causes, from infections to autoimmune diseases. Although pericarditis is often treatable, it is important to recognize and treat it early to prevent complications.

What is pericarditis?

Pericarditis is an inflammation of the pericardium, the two-layered membranes that surround and protect the heart. The pericardium is an essential structural element of the heart, consisting of two main layers:

• Parietal layer: the outer layer attached to the surrounding tissue and helps fix the heart in the chest.
• Visceral layer (epicardium): the inner layer that directly contacts the surface of the heart and provides its protection.
• Pericardial cavity: the space between the parietal and visceral layers that contains a small amount of fluid (usually 15–50 mL). This fluid acts as a lubricant, reducing friction between the layers during the heartbeat.

During pericarditis, the pericardium becomes inflamed, which can cause pain and other symptoms. As a result of the inflammation, extra fluid can accumulate in the pericardial cavity, causing a pericardial effusion. If the fluid build-up is significant, it can put pressure on the heart and interfere with its function, leading to a condition called cardiac tamponade. Cardiac tamponade is a life-threatening condition in which the heart is unable to pump blood effectively because it is compressed by the accumulated fluid in the pericardial cavity.

Types of pericarditis

Pericarditis can be classified according to the duration of the disease, the rate of development and changes in the pericardium. The main types are:

Acute pericarditis

• Duration: symptoms last less than 6 weeks.
• Causes: viral infections (coxsackie, cytomegalovirus), autoimmune diseases, heart attack (Dressler's syndrome), injuries, metabolic disorders.
• Symptoms: sharp pain in the chest that worsens when lying on the back, fever, pericardial rub noise.

Subacute pericarditis

• Duration: symptoms last from 6 weeks to 6 months.
• Causes: tuberculosis, tumors, autoimmune processes.
• Symptoms: prolonged chest pain, fatigue, shortness of breath.
• Treatment: depends on the cause; anti-infective therapy, anti-inflammatory drugs.

Chronic pericarditis

• Duration: symptoms last more than 6 months.
• Types:

  • Constrictive pericarditis: thickening of the pericardium, which limits the filling of the heart.
  • Chronic exudative pericarditis: constant accumulation of fluid.
• Symptoms: shortness of breath, fatigue, edema.
• Treatment: surgical pericardiectomy in constrictive pericarditis; pericardiocentesis in exudative pericarditis.

Recurrent pericarditis

• Description: symptoms return after initial recovery.
• Causes: autoimmune reactions, incomplete healing.

Constrictive pericarditis

• Description: thickening and hardening of the pericardium, limiting heart function.
• Symptoms: severe shortness of breath, edema, fatigue.
• Treatment: pericardiectomy (surgical removal of the pericardium).

Exudative (effusion) pericarditis

• Description: accumulation of fluid in the pericardial cavity.
• Causes: infections, autoimmune diseases, tumors.
• Symptoms: shortness of breath, feeling of pressure in the chest.
• Treatment: pericardiocentesis (aspiration of fluid), treatment of the underlying cause.

Hemorrhagic pericarditis

• Description: the presence of blood in the pericardial fluid.
• Causes: injuries, tumors, blood clotting disorders.
• Treatment: urgent pericardiocentesis or surgical intervention.

Dressler's syndrome (post-infarction syndrome)

• Description: Autoimmune pericarditis after myocardial infarction or heart surgery.
• Symptoms: Chest pain, fever.

Uremic pericarditis

• Cause: kidney failure (uramism), accumulation of toxins.
• Treatment: dialysis, NSAIDs, colchicine.

Neoplastic pericarditis

• Cause: invasion of tumors in the pericardium (primary or metastatic).
• Symptoms: shortness of breath, pericardial effusion.
• Treatment: chemotherapy, radiation therapy, pericardiocentesis to relieve symptoms.

Symptoms of pericarditis

Symptoms of pericarditis can be different and depend on the severity of the inflammation, the amount of fluid accumulation and the cause.

Most common symptoms

Chest pain:

• Sharp, stabbing pain in the center or left side of the chest.
• The pain may radiate to the shoulders, neck or back.
• The pain worsens when lying on the back and is relieved by sitting and bending forward.

Shortness of breath:

• During exercise or even at rest.
• Feeling like you can't take a full breath.

Fever and weakness:

• Increased body temperature, chills.
• Fatigue, weakness.

Palpitations:

• Fast or irregular heartbeat.

Klepus:

• Dry cough for no apparent reason.
• Hoarseness or voice changes.

Swelling:

• Swelling of the abdomen or legs in severe cases.

Signs of severe symptoms

Symptoms of cardiac tamponade:

• Low blood pressure, weakness, dizziness.
• Rapid heartbeat.
• Swelling of veins in the neck.

Constructive pericarditis:

• Chronic pericarditis, which causes scarring and thickening of the pericardium.
• The heart is unable to fill with blood efficiently.

When to seek medical help

• Sudden, severe chest pain.
• Shortness of breath that worsens rapidly.
• Fast, irregular heartbeat.
• If symptoms persist or worsen.

Causes of pericarditis

Pericarditis can be caused by a variety of factors, and often the exact cause remains unknown (idiopathic pericarditis).

Causes of infection

Viral infections:

• Coxsackie virus.
• Epstein-Barr virus (EBV).
• Cytomegalovirus (CMV).
• HIV.
• COVID-19 virus (SARS-CoV-2).

Bacterial infections:

• Tuberculosis (Mycobacterium tuberculosis).
• Staphylococci and streptococci.
• Pneumococci.

Fungal and parasitic infections:

• Histoplasma.
• Candida species.

Non-infectious causes

Autoimmune diseases:

• Systemic lupus erythematosus.
• Rheumatoid arthritis.
• Systemic scleroderma.
• Vasculitis.

Cardiac Injuries and Procedures:

• Heart attack (myocardial infarction): Pericarditis can develop after a heart attack (Dressler's syndrome).
• Heart surgery or catheterization.
• Injuries in the chest area.

Metabolic disorders:

• Uremia (kidney failure).
• Hypothyroidism.

Tumors:

• Pericardial metastases from other cancers (lung, breast, lymphoma).

• Radiation therapy in the chest area.

Risk factors for pericarditis

Pericarditis can develop for a variety of reasons, but there are several risk factors that increase the chance of developing this inflammation of the lining of the heart. Understanding these risk factors can help you recognize potential threats and take the necessary steps to protect your health.

Men aged 20 to 50 years

Pericarditis is more common in men in this age group. This may be due to a variety of lifestyle factors and health conditions common to this demographic. For example, young men may be exposed to greater physical exertion or trauma that can cause pericarditis.

Autoimmune disease history

Autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and systemic scleroderma can increase the risk of pericarditis. In these diseases, the immune system becomes reactive against the cells of the body's own tissues, including the lining of the heart, causing inflammation.

Recent heart surgery or trauma

Cardiac surgery, catheterization, or chest trauma can cause pericarditis. This type of intervention can damage the structure of the pericardium or cause infections that lead to inflammation. This is especially important for people who have recently experienced heart trauma or surgery.

Kidney failure or dialysis

Kidney failure, especially chronic kidney disease, can cause pericarditis. When the kidneys are unable to effectively remove toxins from the body, they can accumulate and damage the pericardium, causing inflammation. Dialysis, which is performed to relieve kidney function, may also be associated with an increased risk of pericarditis.

Oncological diseases and their treatment

Cancers, especially those that metastasize to the pericardium, can cause pericarditis. Phyllode tumors, which are malignant breast tumors, can spread to the lining of the heart, causing inflammation. In addition, cancer treatments such as chemotherapy and radiotherapy can affect the structure of the pericardium and contribute to the development of inflammation.

Areas of infection (eg tuberculosis)

Living or traveling to regions with a high prevalence of tuberculosis increases the risk of pericarditis. Tuberculosis can spread to the pericardium, causing infectious pericarditis. These types of infections are rare in developed countries, but may be common in other regions.

Additional risk factors

In addition to the above, there are a few other risk factors that can increase the likelihood of pericarditis:

• Viral infections: viruses such as the influenza virus can cause pericarditis.
• Bacterial infections: Hard-to-treat bacterial infections can cause pericarditis, especially in people with weakened immune systems.
• Pain reactions: sometimes the body responds to severe pain with an inflammatory process that may involve the pericardium.
• Hormonal changes: during pregnancy or during hormonal therapy, pericardial function may change, which increases the risk of inflammation.

How to reduce the risk of pericarditis?

To reduce the risk of pericarditis, it is important to follow a healthy lifestyle and control existing health problems:

• Regular medical check-ups: treat chronic conditions such as kidney failure and autoimmune diseases to reduce the risk of inflammation.
• Healthy lifestyle: maintain a balanced diet, exercise regularly and avoid smoking and excessive alcohol consumption.
• Infection prevention: get vaccinated against influenza and other infectious diseases, especially if you live in regions with a high prevalence of infections.
• See a doctor after an injury or surgery: if you have experienced a chest injury or heart surgery, see your doctor regularly to prevent the development of pericarditis.

Understanding the risk factors for pericarditis and how to control them is essential to maintaining heart health and preventing inflammatory complications. If you have any risk factors or concerns about pericarditis, please consult your doctor for individualized advice and to prevent potential health problems.

Diagnostic methods of pericarditis

Accurate diagnosis is essential to determine the cause of pericarditis and appropriate treatment.

Medical history and physical examination

Medical history:

• Symptoms and their duration.
• Previous illnesses, infections, operations.

Physical examination:

• Auscultation of the heart: Pericardial rub murmur - characteristic sound caused by inflamed pericardial leaflets.
• Measuring blood pressure and pulse.
• Check for fluid retention (edema).

Diagnostic tests

Electrocardiogram (ECG)

• Detects changes in the electrical activity of the heart.
• Typical ECG changes in pericarditis:

  • ST segment elevation.
  • PR segment downgrade.

Echocardiography

• An ultrasound examination that visualizes the heart and pericardium.
• Detects pericardial effusion (accumulation of fluid).
• Assess heart function.

Chest X-ray

• Determines the size and shape of the heart.
• Reveals an enlarged heart shadow if there is a large pericardial effusion.

Computed tomography (CT) and magnetic resonance imaging (MRI)

• More detailed visualization of heart and pericardial structures.
• Helps distinguish pericarditis from other heart diseases.

Blood tests

• Full blood count: leukocyte count, inflammatory markers.
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): elevated in inflammation.
• Troponins: may be elevated in the presence of myocardial damage.
• Autoantibody tests: indicates an autoimmune process.
• Tests for viral and bacterial infections.

Pericardial fluid analysis

Pericardiocentesis:

• Obtaining a fluid sample from the pericardial cavity.
• Laboratory analysis to determine the cause (infection, inflammation, malignant process).

How is pericarditis treated?

The goal of treatment is to reduce inflammation, pain and prevent complications. Therapy is adjusted based on the cause and severity of pericarditis.

Invasive procedures

Pericardiocentesis

• Aspiration of fluid from the pericardial cavity with a needle.
• Performed for diagnostic and treatment purposes.

Indications:

• A large pericardial effusion.
• Cardiac tamponade.

Pericardiectomy

• Surgical removal of part or all of the pericardium.
• Performed in constructive pericarditis, when the pericardium is thickened and restricts heart function.

Supportive therapy

• Recreation: reduce physical activity during acute pericarditis.
• Pain relief: pain relievers as needed.
• Cardiovascular function monitoring: hospitalization in severe cases.

Pericarditis and lifestyle

Living with pericarditis

Regular medical supervision:

• Regular visits to the cardiologist.
• Monitor symptoms and treatment effectiveness.

• Strictly follow your doctor's instructions.
• Inform your doctor about any side effects.

Physical activities:

• Exercise should be limited during acute pericarditis.
• After recovery, gradually resume activities.

Nutrition:

• A balanced diet rich in vitamins and minerals.
• Limit salt intake to reduce fluid retention.

Hydration:

• Adequate fluid intake if there are no contraindications.

• Quitting smoking and limiting alcohol consumption: improves overall health and reduces the risk of complications.

Psychological support

• Emotional support: conversations with family and friends.
• Support groups: sharing experiences with other patients.
• Consultations with a psychologist: anxiety or depression.

Prevention of pericarditis

Although it is not always possible to prevent pericarditis, there are ways to reduce the risk.

Infection prevention

• Observance of hygiene: thorough hand washing.
• Vaccination: against flu, COVID-19 and other infections.
• Avoiding contact with sick people.

Healthy lifestyle

• Strengthening the immune system: healthy diet, enough sleep, physical activity.
• Smoking cessation: reduces the risk of cardiovascular diseases.
• Restriction of alcohol consumption.

Regular medical check-ups

Early detection and treatment of diseases:

• Autoimmune disease surveillance.
• Assessing heart health.

Complications

Without proper treatment, pericarditis can lead to serious complications.

Cardiac tamponade

• The accumulation of fluid in the pericardial cavity interferes with the functioning of the heart.
• A life-threatening condition that requires immediate medical intervention.

Constructive pericarditis

• Pericardial thickening and scarring.
• Limits the heart's ability to fill with blood.
• Surgical intervention (pericardiectomy) may be required.

Chronic pericarditis

• Chronic inflammation that can cause recurring symptoms.
• Long-term therapy and monitoring is required.

Conclusion

Pericarditis is a condition that can be short-term or long-term and can have a significant impact on your health and quality of life. However, with early diagnosis, appropriate treatment and lifestyle changes, many people can make a full recovery or successfully manage their symptoms. It is important to seek medical help in time, follow the doctor's instructions and make the necessary lifestyle changes.