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008.31.10 Pericardial Disease – Acute pericarditis, Chronic Pericarditis: Causes, Symptoms and Diagnosis, Treatment

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The pericardium is a double layer bag, flexible and extensible, which envelops the heart. Between the two layers contains a lubricating fluid that allows them to easily slide over one another. The pericardium holds the heart in place, prevents blood from getting too full and protects it from infection. However, the pericardium is not essential to keep alive the body, when removed, produces no substantial change in the heart’s performance.

In rare cases, you may be born without the pericardium or to submit any weak areas or holes. These defects may be dangerous because the heart or major blood vessel may bulge (hernia) through a hole in the pericardium and become trapped and clogged, which can cause death in minutes. Therefore, these defects are usually repaired by surgery, if the repair is not possible, remove the entire pericardium. Aside from birth defects, diseases of the pericardium may result from infections, injuries and tumors that have spread.

Acute pericarditis

Acute pericarditis is a sudden inflammation of the pericardium is often painful and causes the leakage of fluid and blood products such as fibrin, red blood cells and white cells in the pericardial space.

Acute pericarditis occurs by various causes, from viral infections (which can cause pain but are usually short-lived and leave no sequel) to a life-threatening cancer. Other causes include AIDS, myocardial infarction, heart surgery, lupus erythematosus, rheumatoid arthritis, renal failure, injury, radiation and leakage of blood from an aortic aneurysm (dilation of the aorta in pouch). Acute pericarditis can also occur as a side effect caused by certain drugs such as anticoagulants, penicillin, procainamide, phenytoin and phenylbutazone.

Symptoms and Diagnosis

Generally, acute pericarditis causes fever and chest pain that usually extends to the left shoulder and sometimes down to the left arm. This pain can be similar to a heart attack, but tends to worsen when lying down, coughing or breathing deeply. Pericarditis can cause cardiac tamponade, a life-threatening condition.

The diagnosis of acute pericarditis is made from the description of pain and auscultation with a stethoscope placed over the patient’s chest. Pericarditis produces a popping sound similar to the crunch of leather of a shoe. A chest radiograph and an echocardiogram (a test that uses sound waves to create an image of the heart) can show the presence of fluid in the pericardium. The echocardiogram can also reveal the underlying cause (eg, a tumor), and to show the pressure of the pericardial fluid on the right heart chambers, high pressure is a possible warning sign that there is a cardiac tamponade. On the other hand, the blood test can detect some cases of pericarditis (eg, leukemia, AIDS, infections, rheumatic fever and elevated levels of urea as a result of kidney failure).

Prognosis and Treatment

The prognosis depends on the cause of the disease. When pericarditis is caused by a virus or when the cause is unknown, the recovery was achieved between 1 and 3 weeks. Complications delayed recovery or recurrence. If it is a cancer that has invaded the pericardium, survival rarely exceeds 12 to 18 months.

Generally, people with pericarditis should be hospitalized, receive drugs that reduce inflammation and pain (such as aspirin or ibuprofen) is to check the possible occurrence of complications (especially cardiac tamponade). If intense pain are administered opiates (morphine) or a corticosteroid. The drug most commonly used in case of severe pain is prednisone.

Further treatment of acute pericarditis depends on the underlying cause that has provoked. Cancer patients may respond to chemotherapy (anticancer drug) or radiation therapy, but often must be surgical removal of the pericardium. Patients treated with dialysis for kidney failure, tend to respond when changes are made in dialysis programs. Bacterial infections are treated with antibiotics and pericardial pus drained surgically. Moreover, whenever possible, suspending the administration of drugs that can cause pericarditis.

When there are repeated episodes of pericarditis, a viral infection, injury or unknown cause, is indicated aspirin, ibuprofen or corticosteroids. In some cases, colchicine is effective. If drug treatment is not effective, the pericardium is removed surgically.

Chronic Pericarditis

Chronic pericarditis is an inflammation that results from an accumulation of fluid or thickening of the pericardium, which begins gradually and persists for a long time.

In a chronic pericarditis with effusion, is a slow accumulation of fluid in the pericardium. Usually the cause is unknown, but the disease can be caused by cancer, tuberculosis or an underactive thyroid. When the cause is known, should be treated, if cardiac function is normal, the doctor may take an expectant attitude, ie observation.

Chronic constrictive pericarditis is a rare disease that occurs when fibrous tissue develops (similar to a scar) around the heart. Fibrous tissue gradually shrinks, compresses the heart and reduces its size. This compression increases the pressure in the veins that carry blood to the heart because more pressure is needed to fill it. The liquid-tight, leak out and accumulate under the skin in the abdomen and sometimes in the space around the lungs.

Causes

Any condition that causes acute pericarditis can lead to chronic constrictive pericarditis, but usually the cause is unknown. The most common causes are viral infections and those caused by radiation therapy for breast cancer or lymphoma. Chronic constrictive pericarditis may also result from rheumatoid arthritis, lupus erythematosus, prior injury, heart surgery or a bacterial infection. In Africa and India tuberculosis is the most common cause of pericarditis in any form, while it is rare in developed countries.

Symptoms and Diagnosis

The symptoms of chronic pericarditis are dyspnea, cough (because the high pressure in the veins of the leaves causes lung fluid into the air sacs) and fatigue (because the heart reaches prove inadequate). On the other hand, the condition itself is painless. Also often the accumulation of fluid in the abdomen and legs.

The symptoms are key to making the diagnosis of chronic pericarditis, especially if no other reason to explain the reduction in cardiac output (such as hypertension, a coronary artery disease or valve disease). In chronic constrictive pericarditis, the heart is not big on a chest radiograph, whereas in most other heart conditions it was observed an increase in size. About half of cases of chronic constrictive pericarditis seen in chest radiographs, calcium deposits in the pericardium.

Two types of procedures confirm the diagnosis. Cardiac catheterization can be used to measure blood pressure in the chambers and major blood vessels. Furthermore, to determine the thickness of the pericardium, can be used magnetic resonance imaging (MRI) or computed tomography (CT). Normally, the pericardium has a thickness less than 30 millimeters, but in chronic constrictive pericarditis becomes twice or more.

Treatment

Although diuretics (drugs that remove excess fluid) can improve symptoms, the only treatment is surgical removal of the pericardium. Surgery is curative in about 85 percent of cases. However, since the mortality from this operation is 5 to 15 percent, most patients do not operate unless the disease substantially interferes with daily activities.