Pericarditis and pericardial disease

• What is Pericarditis & Pericardial Disease
• Statistics on Pericarditis & Pericardial Disease
• Risk Factors for Pericarditis & Pericardial Disease
• Progression of Pericarditis & Pericardial Disease
• Symptoms of Pericarditis & Pericardial Disease
• Clinical Examination of Pericarditis & Pericardial Disease
• How is Pericarditis & Pericardial Disease Diagnosed?
• Prognosis of Pericarditis & Pericardial Disease
• How is Pericarditis & Pericardial Disease Treated?
• Pericarditis & Pericardial Disease References

What is Pericarditis & Pericardial Disease

Pericarditis is an inflammation of the Pericardium. The pericardium is the fibrous sheath around the heart.

Statistics on Pericarditis & Pericardial Disease

About 20% of myocardial infarction patients develop pericarditis.

Risk Factors for Pericarditis & Pericardial Disease

The most common causes are viral infections and myocardial infarction.

Other less common causes include:
1) Uraemia secondary to renal failure.
2) Bacterial infections.
3) Tuberculosis.
4) Malignancy: carcinoma of the breasts, lung and lymphomas can cause pericarditis.

Progression of Pericarditis & Pericardial Disease

This varies to some extent with the causative factors. Pericarditis is often without a clearly definable cause. Following an attack either from a microorganism or infarction (heart attack), acute inflammation results.

This may then following various different paths:
1) A pericardial effusion may develop (fluid in between the pericardium and the heart) causing restriction of the normal filling of the heart chambers (cardiac tamponade) a potentially life-threatening condition.
2) Constrictive pericarditis may result: fibrous changes render the pericardium rigid and impair normal ventricular movement.

How is Pericarditis & Pericardial Disease Diagnosed?

Blood tests:
1) The ESR (erythocyte sedimentation rate) is almost always elevated.
2) Cardiac enzymes are usually normal (unless the pericarditis is a complication of myocardial infarction)

Chest x-ray: may show evidence of pleural effusion. In constrictive pericarditis CXR may show calcification and a small heart.

ECG may show:
1) concave up “saddle shaped” ST segment elevations (all leads except aVR).
2) lack of reciprocal ECG changes help distinguish from acute myocardial infarction.

Prognosis of Pericarditis & Pericardial Disease

The prognosis of uncomplicated pericarditis is generally good although the disease can be difficult to treat and can become recurrent. When complications such as effusion, constriction and tamponade develop the disease becomes life threatening and survival rates decline – especially if treatment to drain the effusion and allow the heart to pump adequately is not done early.

How is Pericarditis & Pericardial Disease Treated?

The underlying cause should be treated where possible (eg. bacterial or href=”/tuberculosis-tb/”>tuberculous causes, renal failure).

Analgesia and bed rest for viral or idiopathic pericarditis. Aspirin and NSAIDS are usually sufficient to control the pain of pericarditis.

Patients should be monitored for development of effusion and tamponade or constrictive pericarditis, which require drainage and surgical pericardectomy respectively. Steroids can be given in resistant cases after other approaches have failed.

Pericarditis & Pericardial Disease References

[1] Hurst’s The Heart 8th Edition, McGRAW-HILL 1994.
[2] Kumar and Clark, Clinical Medicine 4th Edition, W.B SAUNDERS 1998.