Human Heart is composed of three layers. The tough, outermost protective covering of the heart is known as Pericardium. Inflammation of the Pericardium is termed as Pericarditis. Pericarditis can be acute or chronic. “Acute” means that it occurs suddenly and usually doesn’t last for a long time(<6 weeks). “Chronic” is one which develops over time and lasts longer(>6 months). Both acute and chronic Pericarditis can disrupt our heart’s normal function and possibly(though rarely) lead to death.
The Pericardium holds the heart in place and helps it work properly. The sac is made of two thin layers of tissue that enclose your heart. Between the two layers is a small amount of fluid. This fluid keeps the layers from rubbing against each other and causing friction.
What are the causes of Pericarditis?
- Infectious: viral(Coxsackie, the most common cause), bacterial (Pneumococus, Tuberculous bacilli), fungal
- Immunological: SLE, Rheumatic fever
- After myocardial infarction
- Cardiac trauma
- Side effects of drugs like isoniazid(anti TB), cyclosporine (immunosuppressant)
- Idiopathic: With out a cause
What are the clinical features?
Chest pain is the classical presentation, relieved by sitting up forward and worsened by lying down. Other symptoms of Pericarditis may include dry cough, fever, fatigue, and anxiety. Pericarditis can be misdiagnosed as Myocardial Infarction (Heart Attack), and vice versa.
Diagnosis of Pericarditis can be made by combining the clinical data combined with information from Chest X-ray, Electrocardiogram, Echocardiography and Pericardiocentesis (putting in a needle into the Pericardial space and analyzing the aspirated fluid). Depending on the type of exudates on aspiration Pericarditis can be classified.
Treatment of Pericarditis involves use of the medications that will subside the inflammation. Painkillers (such as Aspirin, ibuprofen), antibiotics, steroids can be used. Pericardiocentesis, a procedure where a thin needle is inserted through the chest wall into the Pericardial sac, may be considered if too much fluid is present, or to aid in establishing the cause of the Pericarditis(for example, infection, cancer, etc.) by analyzing the fluid that is removed. Pericardotomy(cutting a hole in the Pericardial sac) or Pericardectomy(removing the sac completely) may be needed for recurrent Pericarditis of scarring within the Pericardial sac.