Pericarditis

Pericarditis is a condition involving inflammation of the pericardium, the thin, two-layered membrane surrounding the heart. This inflammation can result in chest pain, fluid accumulation around the heart, and impaired heart function. Though it can affect individuals of all ages, pericarditis is most commonly seen in adult males aged 20–50.

The causes of pericarditis range from viral infections to autoimmune diseases. In most cases, it is self-limiting, but recurrent or chronic cases can severely affect the patient’s quality of life. Understanding this condition is crucial for early recognition and appropriate management.

Pericarditis is an inflammatory condition affecting the pericardium. This sac normally contains a small amount of fluid that prevents friction as the heart beats. In pericarditis, inflammation may lead to an excess of fluid (pericardial effusion), causing pressure on the heart (cardiac tamponade) or fibrous thickening (constrictive pericarditis).

The hallmark symptom is sudden, sharp chest pain that may radiate to the neck or shoulders. The pain is often relieved by sitting up or leaning forward and worsens when lying down or breathing deeply.

India

Accurate data for India is limited, but pericarditis is increasingly recognised, particularly in relation to tuberculosis (TB). TB-related pericarditis remains a major concern in India, especially in rural areas where TB prevalence is high.

Worldwide

Globally, the incidence of acute pericarditis is estimated at 27.7 cases per 100,000 people annually. It accounts for around 5% of emergency department visits for non-ischaemic chest pain.

1. Acute Pericarditis: Rapid onset, often caused by viral infections.
2. Chronic Pericarditis: Lasts longer than three months, often linked to autoimmune conditions.
3. Constrictive Pericarditis: Scarring causes the pericardium to stiffen, restricting heart function.
4. Pericardial Effusion: Fluid buildup between the pericardial layers.
5. Cardiac Tamponade: Severe effusion compresses the heart, a medical emergency.

     6. Recurrent Pericarditis: Symptoms return after an initial episode, common in autoimmune cases.
 

• Viral Infections (e.g. Coxsackievirus, HIV, COVID-19)
• Bacterial Infections (e.g. tuberculosis)
• Autoimmune Disorders (e.g. lupus, rheumatoid arthritis)
• Heart Attack or Heart Surgery
• Cancer and Radiation Therapy
• Kidney Failure (Uremic Pericarditis)
• Medications (e.g. hydralazine, isoniazid)
• Idiopathic: No identifiable cause
   

• Sharp or stabbing chest pain
• Pain that improves when sitting up
• Shortness of breath
• Low-grade fever
• Heart palpitations
• Fatigue or weakness
• Swelling in the legs or abdomen (in chronic cases)

Symptoms may vary depending on the underlying cause and whether complications are present.

• Physical Exam: Listening for a pericardial rub with a stethoscope.
• Electrocardiogram (ECG): Reveals characteristic changes in electrical activity.
• Chest X-ray: Shows enlarged heart if there’s fluid buildup.
• Echocardiogram: Ultrasound to detect fluid and assess heart function.
• Cardiac MRI or CT Scan: Detailed imaging of the pericardium.
• Blood Tests: Identify infection or autoimmune markers.

Timely diagnosis is crucial to prevent complications like cardiac tamponade.

Medications

• NSAIDs (e.g. ibuprofen, aspirin): First-line treatment to reduce inflammation and pain.
• Colchicine: Prevents recurrence when used with NSAIDs.(Bran 200mg Tablet)
• Corticosteroids (e.g. prednisone): For cases not responsive to standard therapy. (Adred 20mg Tablet)
• Antibiotics: For bacterial pericarditis.
• Antituberculosis Therapy: In TB-related pericarditis.
• Immunosuppressants: In autoimmune-related cases.

Procedures

• Pericardiocentesis: Draining excess fluid with a needle.
• Pericardiectomy: Surgical removal of the pericardium in chronic or constrictive cases.

Lifestyle and Nutritional Support

• Bed rest during acute phase
• Avoidance of intense physical activity
• Heart-healthy diet to support recovery

• Herbal Supplements: Turmeric and ginger for their anti-inflammatory properties (consult a physician first).
• Mindfulness and Stress Reduction: Meditation, breathing exercises
• Acupuncture: Some patients report relief in chronic pain conditions

These should always be used in conjunction with conventional treatment.

• Male gender (particularly ages 20–50)
• Recent viral illness
• Autoimmune diseases
• Cancer or radiation therapy
• Kidney failure
• History of heart attack or cardiac surgery

• Cardiac Tamponade: Life-threatening pressure on the heart.
• Constrictive Pericarditis: Permanent scarring restricting the heart.
• Recurrent Pericarditis: Frequent flare-ups.
• Chronic Pain or Fatigue: Impacts quality of life.

These complications require immediate medical intervention.

• Rest Adequately: Especially during acute episodes
• Monitor Symptoms: Report chest pain or breathlessness promptly
• Follow Medical Advice: Stick to the prescribed regimen
• Join a Support Group: Shared experiences can be emotionally uplifting
• Stay Informed: Understanding your condition aids better self-management

• “It’s just heartburn”: Misdiagnosis can delay proper care
• “It only affects old people”: Young adults, especially males, are at higher risk
• “Once treated, it won’t return”: Recurrences are common
• “It always requires surgery”: Most cases respond well to medication

• Severe or sudden chest pain
• Shortness of breath
• Swelling of legs or abdomen
• Rapid heartbeat
• Symptoms not responding to medication
• Delays in treatment may result in life-threatening complications.

• What caused my pericarditis?
• What is the likelihood of recurrence?
• What treatment options are best for my case?
• Are there long-term complications?
• Should I avoid any specific activities or foods?
• How often should I follow up?

• Be Understanding: Fatigue and chest discomfort can be persistent
• Encourage Medical Compliance: Reminders for medication and appointments
• Prepare Heart-Healthy Meals: Support dietary needs
• Help with Physical Tasks: Especially during flare-ups
• Be a Good Listener: Emotional support is invaluable

Pericarditis, though often manageable, can become a serious health concern if left untreated. Early diagnosis, appropriate medication, and lifestyle adjustments are essential for recovery and long-term well-being. Understanding and support from caregivers and the community also play a critical role in improving outcomes.