Pericarditis is an inflammatory disease of the pericardium; a fibrous sac surrounding the heart. The main symptom of pericarditis is sharp stabbing chest pain, usually worse on breathing in and lying down. Pericarditis is a relatively common cardiac disease. 5% of all patients presenting to A&E with chest pain have pericarditis. Pericarditis is more common in men than women and in adults and the elderly than in children.
Pericardium is a double-layered fibrous sac around the heart. The layers of pericardium are separated by a small amount of viscous fluid. Pericardium works as a shock absorber which protects the heart from injury and variation in the blood pressure. Pericardial fluid acts as a lubricant to minimize friction during cardiac contraction and relaxation. Due to its role in protecting the heart, even a mild inflammation can cause considerable chest discomfort mimicking a heart attack.
Symptoms last less than three months and usually improve within a week or so. Most cases of acute pericarditis are assumed to be due to a viral infection but in 90% of patients the exact cause is not found and these cases are then called idiopathic pericarditis.
Approximately 25% of people with acute pericarditis develop recurrent pericarditis. No clear reason has been identified but perhaps the previous infection triggers an immune reaction which leads to recurrence of pericardial inflammation.
Chronic pericarditis lasts more than 3 months and is more likely to be caused by a bacterial infection such as tuberculosis. Chronic pericarditis may result in a pericardial constriction which can lead to heart failure and require surgical intervention.
Non-steroidal anti-inflammatory (NSAIDS) drugs are the treatment of choice for acute pericarditis. In some patients a significant amount of fluid accumulates in the pericardial space and interferes with heart’s pumping function. This complication of pericarditis is called tamponade, is diagnosed by echocardiography and requires urgent drainage to remove the fluid (pericardiocentesis). Colchicine is used for recurring pericarditis because it reduces the risk of relapse. The treatment of chronic pericarditis depends on underlying problem; usually medical treatment is sufficient but in some cases a surgical intervention (pericardiectomy, surgical removel of part or most of the pericardium).