What is acute pericarditis

The heart, like most organs in the human body, is lined with a protective layer, the pericardium. The pericardium is an envelope formed by two layers, the serous pericardium, the innermost one, which is in direct contact with the heart, and the fibrous pericardium, the outermost, more resistant and less able to expand. Between both layers of the pericardium there is a small amount of fluid, intrapericardial fluid, which lubricates them constantly and thus allows the heart to move easily during contraction. If, for whatever reason, a sudden inflammation of the pericardial layers occurs, compromising its function and, consequently, partially altering cardiac function, the patient is said to suffer from acute pericarditis.

How is it produced?

Acute pericarditis has a prevalence of around 1% in the general population and it is estimated that 5% of chest pain for which patients are consulted in the emergency room are due to this cause. About 80% of pericarditis Acute symptoms that occur are of unknown origin, which is called idiopathic, although it is assumed that the vast majority of them can be caused by a viral infection, such as adenovirus, echovirus, influenzavirus or the coxsackie group. However, the diagnosis, treatment, and prognosis do not vary depending on the causative virus.

Other possible causes of acute pericarditis include:

• bacterial infections
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• Yeast infections
• Parasitic or protozoal infections
• Primary neoplasms, such as mesothelioma, sarcoma, fibroma, or lipoma
• Metastases from other tumors, such as lung, breast, lymphomas, or leukemia
• Autoimmune diseases:
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• Scleroderma
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• Reiter's syndrome
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• Polymyositis and dermatomyositis
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• Behçet syndrome
• Churg-Strauss syndrome
• Secondary to acute myocardial infarction, early or late (Dressler syndrome)
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• Pneumonia
• Pulmonary embolism
• Metabolic disturbances
• Chest trauma
• Drugs, such as procainamide, phenytoin, isoniazid, hydralazine, etc.

Symptoms

Acute pericarditis is characterized by the existence of chest pain accompanied by pericardial friction and alterations of the.

• The pain of acute pericarditis is located in the center of the chest or in the left half of the chest. It is a sharp, non-oppressive pain that increases with deep inspiration, coughing, swallowing, or lying down, while it characteristically improves with rising or leaning forward slightly. Sometimes the pain can radiate to the neck, shoulder, or stomach.
• The patient may also have generic infection symptoms, such as fever, general malaise, pain in the muscles and joints and, sometimes, a feeling of shortness of breath.

When examining the patient and performing cardiac auscultation in about 80% of cases, pericardial friction can be seen, which is the result of the friction that occurs between the two inflamed layers of the pericardium as they move one over the other during the heart movements. The characteristics of the friction that occurs may vary depending on the position in which the patient is scanned.

Diagnosis

The essential diagnosis of pericarditis will be based on the patient's description of the pain and on cardiac auscultation, the presence of pericardial friction being sufficient at times to establish the diagnosis.

• It is essential to carry out an electrocardiogram to assess the possible alterations of the same that usually occur in patients with acute pericarditis. It is characteristic of pericarditis that the electrocardiogram shows changes that are modified throughout the evolution of the disease. In general they usually occur 4 different stages of electrocardiographic abnormalities, but only half of the patients present them all. Likewise, it is essential to perform it to rule out that there are no signs of angina pectoris or acute myocardial infarction.
• One should also be performed to assess signs of acute inflammation and leukocytes, which may be elevated, especially at the expense of lymphocytes, as well as markers of myocardial damage. In case of suspicion of autoimmune diseases, specific antibodies can be searched for them.
• One will make it possible to assess the mobilization of the heart, as well as the presence of fluid in the pericardial cavity, being able to assess the presence of a significant pericardial effusion or even cardiac tamponade.
• The chest radiograph may be normal, but an enlarged cardiac silhouette can occasionally be seen, as well as evaluating the presence of pulmonary condensations or pleural effusions. Initially, it would not be necessary to perform other more complex imaging tests.

In the event that the above tests are not conclusive or in the ultrasound suspicion of a possible cardiac tamponade or a serious effusion, a pericardial puncture could be considered, which is called pericardiocentesis.

Treatment

The treatment of most pericarditis, being of viral origin, will be eminently aimed at controlling the symptoms. It is a disease that tends to be self-limiting, that is, it heals on its own, over 2 to 6 weeks.

It is important that the patient rest. Treatment of symptoms of general malaise, arthromyalgia, and chest pain will be treated with aspirin or non-steroidal anti-inflammatory drugs, such as ibuprofen. In the case of symptoms resistant to treatment or with the suspicion of an autoimmune cause, the use of corticosteroids could be considered. Most patients are cured of acute pericarditis without sequelae, but between 15% and 30% may have recurrent pericarditis over a period of about 10 years. A complication of acute pericarditis would be that it became chronic — lasting more than 3 months — or the presence of pericardial effusion, cardiac tamponade, or restrictive pericarditis.

Can it be prevented?

There are no specific measures to prevent acute pericarditis. In case of presenting symptoms compatible with it, it is advisable to go to an emergency center.

What you should know:

• Sudden inflammation of the layers of the pericardium that hinder cardiac function.
• 80% are of unknown cause, although it is assumed that the vast majority of them can be caused by a viral infection.
• The pain is localized in the center of the chest as a sharp, non-oppressive pain that increases with deep inspiration, coughing, swallowing, or lying down. Pericardial friction can be seen.