Chronic pericarditis

The pericardium is a two-layer envelope that surrounds the heart, constituting its outermost layer. Between these two layers is a small amount of fluid (intrapericardial) that constantly lubricates the surfaces and allows the heart to move easily during contraction.

When this envelope is damaged by any cause, the most common being an infection, an inflammation reaction occurs called pericarditis.

Depending on its duration, pericarditis is considered acute (less than 6 weeks), subacute from 6 weeks to 6 months) or chronic (more than 6 months).

In chronic constrictive pericarditis, there is thickening and hardening of the pericardium secondary to prolonged inflammation.

How is it produced?

Generally, the thickening of the pericardium is secondary to an infection (acute pericarditis) or to a chronic pericardial effusion that causes the appearance of scars and stiffness of this envelope. Due to these alterations, the heart is less elastic, limiting the filling of the ventricles.

The main causes of pericarditis include:

• Infections (pericarditis): viruses, bacteria, fungi, tuberculosis.
• Secondary to a heart injury such as after a heart attack or trauma.
• Generalized diseases that affect the heart such as rheumatic fever, lupus erythematosus, or rheumatoid arthritis.
• Drugs, radiotherapy.
• Tumors
• Injury to the aorta.
• In many patients the cause is unknown.

Symptoms

Symptoms can be very nonspecific and similar to other heart conditions. There may be general symptoms such as weakness, fatigue, weight gain, and swelling, especially in the legs and abdomen. A sensation of shortness of breath (dyspnea) may appear, which is usually progressive. One of the most typical findings is distended neck veins.

Diagnosis

Diagnosing the disease can be difficult. This is based on the medical history of the patient, clinical signs of the disease and the study of the pericardium through imaging tests that allow us to see its thickening.

The alterations registered in the electrocardiogram and the image obtained by echocardiography, magnetic resonance and CT are the most used tests.

Treatment

Treatment of this disease includes treating its cause and improving heart function with drugs such as diuretics and sodium restriction in the diet.

The definitive treatment of the disease is surgical. It is called pericardiectomy and consists of cutting and removing part of the pericardium, thus allowing the normal function of the heart to be restored. Surgical treatment is recommended in relatively early stages of the disease.

Prevention

Proper treatment of pericardial diseases that can evolve into chronic pericarditis can avoid it, although in many cases this is not possible.