Pericarditis – Causes, Symptoms, Diagnosis, Treatment
Causes of pericarditis
The most common causes of pericarditis are viral infections that cause benign pericarditis rarely with increased accumulation of fluid and is responsive to anti-inflammatory treatment. In this case the responsible viruses for infection are adenoviruses, coxsackie, echoviruses. Viral pericarditis are preceded or accompanied by febrile episodes, ENT infections.
A particular situation is the post-infarction pericarditis. After an acute myocardial infarction can occur minor pericarditis in a few days with rapid resolution or may occur Dressler pericarditis, in the 3rd week after infarction and may be accompanied by joint pain.
Inflammation of the pericardium with or without fluid in the pericardial sac can occur within neoplastic pathologies. In this case pericarditis develops slowly and is often diagnosed in stage of cardiac tamponade. Cardiac tamponade is a complication of pericarditis in which the accumulated liquid affects the heart filling and can cause a state of shock.
In tuberculosis may appear a pericarditis that develops insidiously and may become chronic like a constrictive dry pericarditis which affects the relaxation and filling of the heart.
Pericarditis can be met after radiation, after heart surgery, in acute pancreatitis or in myxedema (decompensated hypothyroidism in advanced stage), dissection of the aorta in the pericardial sac with haemopericardium.
The main symptom in pericarditis is chest pain (the area corresponding topographic to the heart). The pain character is like a burning or constriction and is relieved in sitting position or bent in case of a redistribution of fluid in the pericardial sac. Lying down intensifies the pain of pericarditis and has the breathing rhythm. It may also be accompanied by cough. Unlike the pain from angina pectoris, pericarditis pain is not responding after administration of nitroglycerin.
The pain from pericarditis may be accompanied by fever, fatigue, joint pain or muscle pain.
In order to establish the diagnosis of pericarditis, you should see a cardiologist, who can detect pericardial friction rub on auscultation (if the liquid quantity is not big) and make investigations that can detect specific signs of pericarditis: ECG, chest radiography, transthoracic ultrasound with visualization of the fluid and kinetic assessment of the heart, CBC with suggestive aspects in case of infection, cardiac enzymes to differentiate acute myocardial ischemia.
Treatment for pericarditis is established under the recommendation of a cardiologist. We recommend rest and medical leave may be required about 2 weeks. Generally, treatment is based on ibuprofen or aspirin with carefully gastric protection and required discontinuation of anticoagulants in patients with chronic anticoagulation. In forms with massive accumulation of fluid, cardiac tamponade with risk of cardiovascular collapse or constituted shock, stabilization is made at ICU with pericardial puncture and pericardial drainage.