The pericardium is a sac-like, double-layered membrane that covers the heart and protects it from neighbouring structures. Between both layers, a small number of liquids act as a lubricant, allowing them to slide over each other.
When the pericardium becomes inflamed, pericarditis occurs. In these circumstances, the level of fluid increases and can clog the heart and prevent it from working properly.
The pericardium is not essential for the body to function, so if you have a congenital defect that cannot be treated, specialists usually decide to remove it.
This pathology mainly affects men between the ages of 20 and 50.
on many occasions, it responds to a viral or bacterial infection, although it can also be associated with:
- Systemic diseases include cancer, kidney failure, leukaemia, HIV, rheumatoid arthritis, or systemic lupus erythematosus.
- Cardiac pathologies or surgeries: This category includes myocardial infarction and myocarditis.
- Chest trauma, injury to the oesophagus or heart.
- Certain treatments include radiation therapy and certain drugs, such as anticoagulants, procainamide, penicillin, phenytoin, and phenylbutazone.
In the clinical picture of acute pericarditis, pain in the precordial region (anterior and central area of the chest) stands out, which can be intense and oppressive and sometimes radiates to the back, neck and left shoulder arm.
The pain is accentuated by deep inspiration, lateral movements of the chest, and when the patient lies on his back. Some patients experience constant pain at the sternum level similar to that produced by acute myocardial infarction, in which case fever and tachycardia may appear.
Chronic pericarditis, meanwhile, is accompanied by dyspnea, cough (due to the expulsion of fluid into the alveoli caused by high pressure in the veins) and fatigue (due to poor heart function). Fluid deposition in the abdomen and legs is also common, but the condition is virtually painless.
Currently, there are no defined measures to prevent the onset of this disease.
There are two types of pericarditis:
Acute pericarditis is a sudden inflammation of the pericardium. This inflammation, which lasts less than six weeks, is painful and often leads to pericardial effusions, that is, the accumulation of fluid and blood products such as fibrin or red and white blood cells, between the membrane that is attached to the heart and the one in contact with the lungs.
The disease causes fever and chest pain similar to that caused by a heart attack that tends to spread to the left arm. A small percentage of patients affected by benign acute pericarditis present relapses. Suppose the symptoms reappear when anti-inflammatory treatment is stopped or simply after some time free of discomfort. We may be facing incessant or recurrent pericarditis. If so, the cause would have to be reconsidered since it could be secondary pericarditis caused by another disease.
Chronic pericarditis appears as a result of fluid accumulation or thickening of the pericardium that can cause retraction and calcification of the pericardium. In such a case, we speak of constrictive pericarditis.
This type of pericarditis, which lasts more than six weeks, can cause right ventricular failure, that is, oedema or fluid accumulation in the abdominal area and the ankles and pretibial region.
Chronic constrictive pericarditis occurs due to the appearance of fibrous tissue around the heart that compresses it and prevents its normal dilation. This compression increases the pressure in the veins that carry blood to the heart so that the fluid ends up stagnating and, in its attempt to flow out, accumulates in the abdomen and even in the space around the lungs.
Acute pericarditis can be detected from cardiac auscultation and the description of pain. For example, a chest X-ray and an echocardiogram may reveal the presence of fluid in the pericardium. On the other hand, blood tests can detect some of the causes, including leukaemia or HIV.
A chest x-ray can also show calcium deposits in the pericardium, although it may not be conclusive. A catheterisation or an MRI help confirm the diagnosis, and the size of the pericardium increase.
Treatment depends on how pericarditis presents itself and what causes it.
Generally speaking, patients must be hospitalised and given anti-inflammatories. However, when the pain is very severe, doctors recommend the administration of opiates or corticosteroids.
In addition, the possible appearance of complications must be controlled, especially cardiac tamponade, as it is life-threatening. If drug treatment does not resolve the episode of pericarditis, it will be necessary to go through the operating room to remove the pericardium. Surgical intervention is unavoidable in the case of constrictive pericarditis, although it is only effective in 85 per cent of cases.
The course and prognosis of the disease are highly variable. In fact, in some cases, although the disease is in a mild stage, it can progress to become a life-threatening condition. Also, the prognosis will worsen if fluid buildup around the heart or the heart muscle is not working properly.