Acute pericarditis is an inflammation of the sac surrounding the heart, called the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction..
This structure forms a thin, closed pouch that contains the heart.
Further reading: The PericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction.
The Heart Within a Lubricated Sac
The heart is constantly in motion. With every heartbeat, it contracts and relaxes tens of thousands of times each day.
Without protection, these repeated movements could create friction, much like rubbing your hands together, which generates heat and, over time, irritation.
Fortunately, the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. contains a small amount of fluid that acts as a lubricant, much like the fluid found within a joint.
This fluid allows the heart to move freely within its surrounding sac, preventing friction.
Three Forms of Pericarditis
There are three main forms of pericarditis:
- Acute pericarditis;
- Recurrent pericarditis;
- Chronic pericarditis, sometimes referred to as constrictive pericarditis.
Combined Involvement of the Heart Muscle
Sometimes the terms myopericarditis or perimyocarditis are used when inflammation affects both the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. and the heart muscle (myocardium).
Involvement of the heart muscle generally requires closer monitoring and a longer recovery period.
BloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood tests measuring troponins, proteinsProteins are fundamental components manufactured by the cells of our body. They play an essential role in many biological functions, acting as hormones, antibodies, and even cholesterol transporters, among others. >> released by injured heart muscle cells, can help identify this combined involvement.
Causes of Acute Pericarditis
Several conditions can lead to acute pericarditis:
- viral infections (the most common cause);
- bacterial infections;
- following a myocardial infarction (post-infarction pericarditis);
- following heart surgery (post-pericardiotomy syndrome);
- following thoracic surgery;
- following catheter-based arrhythmia treatment (catheter ablation);
- associated with kidney failure (uremic pericarditis);
- following radiation therapy (radiation-induced pericarditis);
- inflammatory diseases such as:
- rheumatoid arthritis;
- scleroderma;
- systemic lupus erythematosus;
- severe infections such as HIV or tuberculosis;
- certain medications that affect the immune system.
It is important to remember that, despite a thorough evaluation, no specific cause may sometimes be identified. This situation is referred to as idiopathic pericarditis, a relatively common condition often believed to result from an unrecognized viral infection.
Causes of Chronic (Constrictive) Pericarditis
The chronic form is less common and generally develops over time when inflammation persists or recurs repeatedly.
It may be related to:
- repeated episodes of acute pericarditis;
- certain infections, particularly tuberculosis;
- an associated inflammatory disease;
- certain cardiac or thoracic procedures;
- prior radiation therapy.
In this form, the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. becomes thicker and more rigid, which can limit the heart’s normal expansion and interfere with its ability to function properly.
This constriction of the heart leads to a backup of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood in the abdominal organs, particularly the liver, as well as in the venous system. Swelling of the abdomen and legs is commonly observed.
Further reading: Constrictive Pericarditis.
Symptoms
Chest pain remains the most common symptom. It is often described as sharp, sometimes like a stabbing pain, and has several characteristics that can help guide the diagnosis:
- worsens with deep breathing;
- worsens when lying flat on the back;
- improves when sitting up or leaning forward.
Its intensity can be striking and particularly alarming. It is not uncommon for it to prompt a person to seek medical attention quickly, fearing a serious heart condition.
In some individuals, the pain may also radiate to the neck, shoulders, back, or trapezius region, a feature that is relatively characteristic of pericarditis.
Unlike angina, which typically occurs with physical exertion and improves with rest, pain caused by pericarditis is usually more constant and varies according to body position and breathing movements.
Other symptoms may also be present:
- fever;
- fatigue;
- shortness of breath or difficulty taking a deep breath because of the pain.
A Distinctive Sound Heard During Heart Examination
During a physical examination, a healthcare professional may sometimes hear a characteristic sound known as a pericardial friction rub. This finding is relatively uncommon and occurs in fewer than one out of three cases.
It is directly related to the movement of the heart. As mentioned earlier, the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. normally contains a small amount of fluid that acts as a lubricant.
Thanks to this fluid, the two layers of the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. slide smoothly over one another, making this movement completely silent.
When the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. becomes inflamed, this sliding motion is no longer as smooth. The surfaces become rougher and rub against each other with every heartbeat.
This friction is what the physician can hear through a stethoscope.
The sound is often described as a scratchy or grating noise, similar to the rubbing of two pieces of Styrofoam or two dry surfaces sliding against one another.
Tests That May Be Helpful
A healthcare professional can often suspect pericarditis simply from the description of the pain and symptoms reported by the patient.
Certain tests may then support this clinical impression and help confirm the diagnosis:
- An electrocardiogram (ECG), which may show characteristic changes associated with inflammation of the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction.;
- BloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood tests, which can detect significant inflammation within the body;
- Troponin, a bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood marker of heart muscle injury;
- Echocardiography, which can help identify a pericardial effusion, meaning an accumulation of fluid around the heart.
Less commonly, a cardiac magnetic resonance imaging (cardiac MRI) study may be requested. This examination allows precise visualization of pericardial inflammation and, when necessary, can determine whether the heart muscle is also affected.
Treatment
Acute pericarditis generally follows a favorable course.
In most cases, it resolves within a few weeks with treatment aimed at reducing inflammation of the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. and relieving pain.
Treatment mainly consists of:
- anti-inflammatory medications prescribed for a period generally ranging from 3 to 8 weeks, such as naproxen or ibuprofen;
- the frequent addition of colchicine, an anti-inflammatory medication that has been used since ancient times and is still used today to treat gout. Its use helps reduce the risk of recurrence;
- acetaminophen as needed for pain relief. It can be used in combination with the other prescribed medications;
- in certain situations, other medications may be required depending on the course of the disease and its underlying cause.
- Beware of Stopping Treatment Too Early
It is not uncommon for some patients to stop their treatment as soon as their chest pain has completely disappeared.
While this decision may seem logical, it is a common mistake. Even though the symptoms have resolved, the inflammation may still be present and not yet fully healed.
The goal of treatment is therefore not only to eliminate the pain but also to allow the inflammation to resolve completely.
For this reason, it is important to continue treatment until it has been completed exactly as prescribed by the healthcare professional. Stopping treatment prematurely increases the risk of recurrence.
- Rest Is Part of the Treatment
Rest is an important component of pericarditis treatment.
During the acute phase, strenuous physical activity should be avoided in order to allow the heart and its surrounding sac to recover properly.
Walking and light activities are usually permitted, depending on symptoms and the recommendations of the healthcare professional.
Athletes and individuals who participate in intensive sports generally need to suspend training and competition for a period of time. Physical activity is then resumed gradually.
When pericarditis is accompanied by inflammation of the heart muscle (myocarditis or myopericarditis), the period of rest is often longer and activity restrictions are more significant.
- Antibiotics Are Rarely Necessary
Antibiotics are usually not helpful because most cases of pericarditis are caused by viruses rather than bacteria.
Depending on the identified cause and the course of the disease, other treatments may occasionally be required, but these situations remain relatively uncommon.
- Cortisone: A Treatment Reserved for Specific Situations
Corticosteroids, often referred to as cortisone, are generally not used as first-line treatment.
Although they can be beneficial in certain specific situations, their use is associated with a higher risk of recurrence and is therefore reserved for selected cases.
Pericardial Effusion
A pericardial effusion is an abnormal accumulation of fluid between the two layers of the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction..
When the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. becomes inflamed, it may produce excess fluid. This can be compared to what happens in an irritated joint, such as a knee that swells because of inflammation.
In most cases, the effusion is small and does not cause any major problems. When it develops slowly, the pericardiumThe pericardium is a sac surrounding the heart and containing a lubricating fluid that allows it to glide with each beat without friction. usually has enough time to adapt by gradually stretching.
The situation is different when the accumulation is large or occurs rapidly. The fluid may then place pressure on the heart and interfere with its normal filling.
In the most severe cases, a complication known as cardiac tamponade may develop. The heart becomes compressed within its own surrounding sac and is no longer able to pump bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood effectively throughout the body.
Cardiac tamponade is a medical emergency that usually requires prompt drainage of the fluid using a needle or a catheter inserted into the pericardial space.
Fortunately, this complication is uncommon. Nevertheless, it helps explain why medical follow-up and repeat testing are sometimes necessary after a diagnosis of pericarditis.
The Role of Echocardiography
Echocardiography is an important test in the evaluation and follow-up of pericarditis.
It allows real-time visualization of the heart and the space surrounding it, particularly to detect the presence of fluid around the heart (pericardial effusion).
It is important to understand that an echocardiogram can be completely normal at the time of diagnosis.
Indeed, this test alone cannot confirm or rule out pericarditis. The diagnosis relies primarily on the patient’s symptoms, the physical examination, and other complementary tests.
Echocardiography is mainly used as a monitoring tool.
It helps determine whether fluid is present around the heart, assess its extent, and follow its evolution over time.
Course and Follow-Up
Although acute pericarditis generally follows a favorable course, medical follow-up remains important.
This follow-up helps ensure:
- that the inflammation has resolved;
- that no complications have developed;
- that the prescribed medications are well tolerated;
- that any pericardial effusion is evolving appropriately;
- that any recurrence is detected promptly.
Some individuals may experience a return of symptoms or repeated episodes of pericarditis in the months following the initial diagnosis.
Fortunately, in the vast majority of cases, the outcome is favorable and recovery is complete.
When Should You Seek Medical Attention Again?
Although most cases of pericarditis heal with relatively simple treatment, it is important to seek medical attention again if symptoms persist, return, or worsen.
New chest pain, worsening shortness of breath, or a deterioration in overall health should also prompt a medical reassessment.
This evaluation will help ensure that recovery is progressing normally and, if necessary, allow adjustments to treatment or the frequency of follow-up visits.
In Summary
Pericarditis is an inflammation of the sac surrounding the heart, known as the pericardium.
It is most commonly caused by a viral infection and generally follows a favorable course.
The main symptom is a distinctive type of chest pain that is often influenced by breathing and body position.
During the physical examination, a characteristic sound called a pericardial friction rub may sometimes be heard, reflecting the loss of the normal smooth movement around the heart.
In some cases, fluid may accumulate around the heart.
When this accumulation is significant or develops rapidly, it can compress the heart and require special attention.
Echocardiography plays an important role in monitoring the condition, even though it may be normal at the time of diagnosis.
Treatment mainly consists of anti-inflammatory medications, sometimes combined with colchicine, along with an appropriate period of rest.
Medical follow-up is recommended to ensure recovery, monitor progress, and help prevent recurrences.
In the vast majority of cases, the outcome is favorable and recovery is complete.
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