Pericarditis is an inflammation of the heart sac. Causes of this disorder are diverse; therefore, pericarditis treatment depends directly on the cause of inflammation. Timely diagnostics and accurately prescribed treatment will help to avoid development of complications. Below we will discuss this condition, its` symptoms and treatment options in more detail.
Pericarditis is the swelling and irritation of the thin sac-like membrane surrounding your heart. This membrane is known as the pericardium. This condition often causes sharp chest pain that occurs when the irritated layers of the pericardium rub against each other. Pericarditis is often very acute – meaning it usually begins suddenly but doesn’t last long), however when symptoms develop more gradually or persist, it becomes a more chronic condition. Most cases of heart sac inflammation are mild and usually improve on their own. Treatment for more-severe cases may include medications and in some cases, although very rarely, surgery. Early diagnosis and treatment can aid in reducing the risk of long-term complications from pericarditis.
SYMPTOMS OF PERICARDITIS
Acute pericarditis usually lasts less than a few weeks. Chronic and recurrent types of this disease, on the other hand can last much longer. Pericarditis has two types:
- The continuous type that occurs within six weeks of weaning medical treatment for an acute episode
- The sporadic type, which occurs after six weeks.
The most common symptom of acute pericarditis is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However acute pericarditis is also sometimes described as more of a dull, achy or pressure-like sensation in the chest and with varying intensity. The pain of acute pericarditis may travel into your left shoulder and neck and is often intensified when you inhale deeply, cough or lie down. Sitting up and leaning forward can often ease the pain. It may at times, be difficult to distinguish pericardial pain from the pain of a heart attack. Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart. This is known as pericardial effusion. The most common symptom of chronic pericarditis is chest pain. Depending on the type, signs and symptoms of pericarditis may include some or all of the following:
- Sharp, piercing chest pain or left side or centre of the chest
- Heart palpitations
- Swelling of the leg or abdomen
- Shortness of breath when in a reclined position
- Low-grade fever
- An overall sense of weakness, fatigue or feeling sick
PERICARDITIS TREATMENT OPTIONS
Your treatment choice for pericarditis will depend on the cause as well as its severity. In some mild cases of pericarditis, treatment may not be necessary as the problem goes away on its own.
Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed, including:
- Over-the-counter pain relievers: Often, pain relievers available without the need for a prescription, such as aspirin or ibuprofen (Advil, Motrin IB, others) will be enough to relieve the pain of pericarditis. These medications help lessen inflammation and pain. Symptoms should start to improve within a day or so, and in many cases may be the only treatment necessary. Prescription-strength pain relievers can also be used.
- Colchicine (Colcrys): This drug reduces inflammation in the body and can reduce the length of pericarditis symptoms whilst decreasing the risk that the condition will recur. However, the drug is not safe for people taking certain medications as well as people with certain pre-existing health conditions, such as liver or kidney disease. Your doctor will carefully check your health history before prescribing colchicine.
- Corticosteroids: If your symptoms persist, your doctor may prescribe prednisone – a steroid medication.
Acute episodes of pericarditis typically last a few weeks, however, future episodes have been known to occur. Some people with pericarditis have a recurrence within a few months after the original episode. When a bacterial infection is the underlying cause of pericarditis, you’ll also be treated with antibiotics and drainage (if necessary).
Hospitalization and procedures
If your doctor suspects cardiac tamponade – a dangerous complication of pericarditis that is caused by fluid buildup around the heart –, you will likely need to be hospitalized. When cardiac tamponade is present, you may need a procedure called pericardiocentesis.
- Pericardiocentesis: This procedure involves using a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You’ll receive a local anesthetic before undergoing this procedure. This procedure is often done with echocardiogram monitoring and ultrasound guidance. This drainage may continue for several days during the course of your stay in hospital.
- Pericardiectomy: If you’re diagnosed with constrictive pericarditis, it may be necessary to completely remove your pericardium (pericardiectomy).
DIAGNOSIS FOR PERICARDITIS
- Consult with the doctor and physical exam: Your doctor will likely start the examination by asking you a series of question about your symptoms and taking your medical history. As part of your initial evaluation, your doctor will place a stethoscope on your chest to listen for the sounds associated with pericarditis – which are made when the pericardial layers rub against each other (pericardial rub). Determining whether you’ve had a heart attack, whether fluid has collected in the pericardial sac, or whether there are any signs of inflammation present is also important and can result in you undergoing more tests including:
- Electrocardiogram (ECG): Patches with wires (electrodes) are attached to your skin in order to measure the electrical impulses your heart gives off.
These impulses are recorded as waves displayed on a monitor or are printed on paper.
- Chest X-ray: With an X-ray of your chest, your doctor can see the size and shape of your heart and determine whether there is an accumulation of excess fluid in the pericardium.
- Echocardiogram: This test uses high-frequency sound waves to create an image of your heart and its structures. This test is viewed on a monitor and can make it possible to detect fluid accumulation in the pericardium.
- Computerized tomography (CT): This X-ray technique can produce more-detailed images of your heart and the pericardium than conventional X-rays can. CT scanning may be performed to rule out any other causes of acute chest pain, such as a tear in your aorta (aortic dissection) or a blood clot in a lung artery (pulmonary embolus). CT scanning can also be used to look for thickening of the pericardium that may indicate constrictive pericarditis.
- Cardiac magnetic resonance imaging (MRI): This technique uses a magnetic field and radio waves to create cross-sectional images of your heart that can reveal whether there are abnormal changes occurring in your pericardium such as thickening or inflammation.
Your doctor may also use blood tests to determine if there is a bacterial or other type of infection present.