Understanding Pericarditis: Causes, Symptoms, and Treatment

Inflammation of the connective tissue covering the heart can have many causes. It usually manifests itself as pain behind the breastbone and can severely impair cardiovascular function. The pericardium (peri = surrounding; card = related to the heart) surrounds the heart muscle as a protective layer of connective tissue. It consists of two skins, whereby only the inner and outer skins of the heart muscle are firmly attached and are thus pushed against the outer skin during its pumping work. Inflammation of the pericardium occurs as an independent disease or is an accompanying reaction of other processes in the organism.

Causes of Pericarditis

The most common cause of pericarditis is an infection  – mostly with viruses, less often with bacteria and other pathogens.

Rheumatic fever, a complication of an infection with certain bacteria, can also cause pericarditis, often involving the endocardium and the heart muscle (myocardium). This leads to an incorrect immune system reaction, in which the defence is directed against the body’s tissue – in this case, heart tissue – and causes inflammatory reactions. The same thing happens with other autoimmune diseases, such as rheumatic diseases of the musculoskeletal system and hypersensitivity reactions to medication, for example.

It is not uncommon for pericarditis to also occur after a heart attack, with an early form being distinguished within 24 to 48 hours after the infarction from a late form two to three weeks later.

Other causes of pericarditis are : 

• hypothyroidism
• renal insufficiency
• connective tissue diseases of the organism
• tumours growing in the chest
• cardiac surgery

In 20 to 30 per cent of the diseases, no clear cause can be found.

 

Symptoms of Pericarditis

As with inflammation, pericarditis accompanies increased blood flow to the tissue structures. Inflammatory cells from the circulating blood accumulate in the tissue, releasing increased tissue fluid. Whether and to what extent symptoms occur depends on whether there are only inflammatory deposits in the contact area of ​​the two pericardial membranes or whether fluid accumulates in the pericardial sac (effusion).

In the first case – so-called dry pericarditis – breathing-related chest pains are in the foreground, typically worsening when lying down and coughing and decreasing when bending over.

In the second case, the pericardium fluid can impede the heart muscle’s regular relaxation and blood filling so severely that the cardiovascular function is impaired (cardiac tamponade). Signs include physical weakness, difficulty breathing, and upper abdominal discomfort.

In the worst case, a circulatory shock occurs.

Acute and chronic pericarditis

A distinction is made between acute pericarditis, which heals after a single treatment, and chronic pericarditis, in which fluid is permanently detected in the pericardium or flare-ups of inflammation repeatedly.

Both forms can be mild or – as described above – lead to acute life-threatening situations due to a pericardial effusion. However, fluid accumulation is usually more severe in the acute form because it is very pronounced (sometimes more than a litre) and builds up so quickly that the heart can no longer compensate. Impairment of the cardiac function up to cardiovascular shock with a fatal outcome can be the result.

 

Armored heart is a special form of chronic pericarditis

A unique chronic form is the so-called armoured heart, in which the pericardium shrinks and scars due to recurring inflammatory reactions, thereby losing its elasticity and, like a rigid coat, no longer allowing the heart to develop.