Did you know that your heart can also get infected or inflamed? Yes, there are various sites in the heart structure that can become susceptible to infections under certain circumstances. One of them is the pericardium, a two layered membrane or sac that covers the outer aspect of the heart. And, inflammation or infection of the pericardium is called pericarditis. Under normal circumstances the pericardium contains around 50 ml of fluid. Once pericarditis sets in, variable amounts of excess fluid get secreted into the pericardial space, which may range from mild to severe.
There are two types of pericarditis: acute and chronic. The acute pericarditis recedes within 5-6 weeks by proper medication. But if the medication is discontinued or not taken properly, the condition worsens and leads to chronic pericarditis. Pericarditis can also progress within few weeks after a heart attack or heart surgery. The symptoms of pericarditis are: sharp chest pain, shortness of breath, palpitation, fever and cough. Dr Santosh Kumar Dora, Cardiac Electro Physiologist, Asian Heart Institute offers a detailed insight into the condition.
There are various causes of pericarditis. The commonest cause is a bacterial or viral infection. In India,tuberculosis is one of the common causes, but it can also occur due to a viral infection. In children, rheumatic fever is a common cause of pericarditis. Other causes include:
In some cases, the underlying cause may not be identified. This is called idiopathic pericarditis.
Pericarditis can affect almost anyone, but is more commonly seen in children and people with lowered immunity or immuno-compromised people. Patients with autoimmune diseases and patients needing radiotherapy are also at a risk of developing pericarditis.
The most common symptom of pericarditis is chest pain. It is usually sharp and stabbing in nature and is caused by friction between the two layers of pericardium during cardiac contraction and relaxation. Chest pain may even be aggravated by reclining and could be relieved to some extent by sitting and stooping forward. Apart from chest pain, patients may also experience breathlessness and coughing
If you have any kind of chest pain symptomatic of heart disease, your doctor may perform a physical examination to identify whether it is due to pericarditis. An examination with a stethoscope that reveals a typical sound (called pericardial rub) is an indication of the condition. With relevant history, characteristic chest pain and hearing of pericardial rub the condition is confirmed. An echocardiogram and electrocardiogram may be suggested to further study the severity of the condition. An echocardiograph shows the extent of fluid collection in the pericardial sac. If it is severe, then the doctor may have to tap it out by inserting a needle.
Treatment depends on the underlying cause. In cases where pericarditis is caused by a viral infection, it is usually self limiting. In such cases, treatment is usually given to relieve the symptoms. To treat chest pain for example, analgesics may be prescribed for a few days to weeks. For the entire duration of the treatment however, close vigilance is kept on kidney function as these drugs may harm the kidneys. Overall, the prognosis is good.
If the inflammation is due to tuberculosis, then prolonged treatment with anti-tubercular drugs is required. The prognosis is good with proper medication if taken for the prescribed duration. In some cases of recurrent pericarditis, treatment is required for a longer period.
In occasional cases, when the fluid builds up in pericardial sac significantly, then it is tapped out by inserting a needle in the pericardial space.
As it most commonly occurs as a complication from a viral infection like tuberculosis, no definitive preventive methods are available. Immunocompromised patients should be particularly cautious about the risk of infection.
The content has been verified by
Dr Santosh Kumar Dora
, Cardiac Electro Physiologist, Asian Heart Institute.