Pericardial Disease or Diseases of the Pericardium

The pericardium is a thin membrane that envelopes and protects the heart. Pericardial disease or pericarditis is an inflammation of the pericardium. Pericarditis is characterised by pericardial friction rub (an audible sound of rubbing heard along with the heart beat), chest pain and changes in an electrocardiogram (ECG, test to evaluate the heart function). It is seen more commonly in men than in women. There are 2 types of pericarditis:

• Acute Pericarditis: It is commonly caused due to a viral infection, and gets resolved spontaneously without treatment. However, acute pericarditis due to bacterial infection may cause pericardial effusion (accumulation of fluid in the space between heart and pericardium). It may hinder the normal functioning of the heart and can even be fatal
• Chronic Pericarditis: In chronic pericarditis, the inflammation increases and thickens the pericardium. It is also called constrictive pericarditis as the thick pericardium constricts and restricts the functioning of the heart. This condition often causes progressive heart failure

Causes

Acute pericarditis may be caused due to:

• Viral, bacterial or fungal infection
• Rheumatic fever
• Heart attack
• Rheumatoid arthritis (inflammation of joints)
• Systemic lupus erythematosus (attack of healthy tissue by body’s defense system)
• Open heart surgery
• Hypothyroidism (less than normal levels of thyroid hormone)
• Kidney failure
• Chest injury
• Metastatic cancer (cancer that has spread from its original site)

Chronic pericarditis may occur due to the recurrence of acute pericarditis or due to a chronic infection such as tuberculosis.

Symptoms

In cases of acute pericarditis, you may experience fever, and sudden and intense chest pain that radiates to the neck, shoulder, arms or back. The pain may get worse when taking deep breathes and while changing position. Chronic pericarditis may lead to symptoms such as swelling due to fluid retention in the legs and abdominal region, fatigue and difficulty in breathing.

Some cases of pericardial disease may not show any symptoms.

Diagnosis

Your physician may recommend blood and urine tests to determine the cause of infection. Your doctor may order a chest X-ray to assess inflammation. You may also be advised to undergo an ECG and echocardiogram (a test that tracks the echoes of sound waves, bouncing off the heart) to determine the heart’s rhythm and functioning. Your doctor may remove a sample of the pericardial fluid surrounding the heart to identify the organism that has caused the infection. Imaging tests like CT scan and MRI may also be recommended.

Treatment

Treatment options for pericardial disease may include:

• Medication: Antibiotics to reduce the infection and inflammation, and painkillers for pain
• Pericardiocentesis: Removal of excess fluid from around your heart
• Pericardectomy: Surgical procedure that removes a part of or the whole pericardium that envelops your heart. This is commonly recommended in case of chronic pericarditis
• You may also be advised to take bed rest and reduce your physical activity to help relieve the pressure on your heart

Dr. Andrew Newcomb will discuss all the options with you and decide on the best treatment for pericardial disease.