This strange chest pain around the heart: Let's know everything about Pericarditis!

Imagine that you suddenly feel a sharp pain in your chest, along with nausea . This pain becomes worse when you take a deep breath or lie down. But surprisingly, when you sit down and lean forward, it seems to decrease a little. Many people fear that this is a heart attack at a time like this. That fear is reasonable, but these symptoms are different from a heart attack, but they can definitely be a condition that requires attention. Today we are talking about this condition related to our heart. That is Pericarditis .

Simply put, what is Pericarditis?

Our heart is not just an organ. It is surrounded by a thin sac-like covering for protection. This is what we medically call the pericardium . The main function of this sac is to reduce the friction that occurs when the heart beats and to protect the heart from infections that come from outside.

So, Pericarditis is an inflammation of the protective sac that surrounds the heart. When we say "inflammation," think of it like when we get injured somewhere in our body, the area becomes red, swollen, and painful. This is a condition that occurs in this sac that surrounds the heart. This usually starts suddenly and can last for weeks or months.

Although this condition can develop at any age, it is most common in men between the ages of 16 and 65. The best part is that it is often successfully treated and cured.

What are the main types of pericarditis?

This condition can be divided into several main types depending on the duration and cause of its development. It is important for you to know this.

In addition, there is a serious complication called Constrictive Pericarditis . This is when the membranes of the sac around the heart become thickened, scarred, and stick together. This limits the space for the heart to beat freely.

What are the symptoms of pericarditis? How do you recognize it?

The main and most common symptom of this condition is chest pain . But this is not a typical chest pain.

• It feels like a sharp, stabbing pain.
• This pain increases when you cough, swallow, breathe deeply, and lie down .
• The pain decreases when you sit leaning forward .

This chest pain can sometimes spread to the back, neck, or even the left shoulder.

In addition to chest pain, you may also have other symptoms such as:

• Difficulty breathing when lying down
• Painful dry cough
• Palpitations (feeling like your heart is beating fast or irregularly)
• Fatigue
• Fever
• Swelling of the legs, ankles, and feet in severe cases

If you have any of these symptoms, see a doctor immediately . If you think your symptoms are severe, go to the nearest hospital emergency room (ETU) as soon as possible. It's not a good idea to put things off.

Why does Pericarditis occur? What are the main causes?

Pericarditis can have several causes. However, in Western countries, it is most often seen as idiopathic or caused by a viral infection. Doctors have divided these causes into two main categories.

1. Infectious causes:

• Viruses: Viruses like influenza, COVID-19, adenovirus, HIV.
• Bacteria: Bacterial infections like tuberculosis.
• Fungi and parasites: These are very rarely seen.

2. Non-infectious causes:

• Chest surgery or accident .
• Cancer that occurs elsewhere in the body.
• Autoimmune conditions: Like lupus and rheumatoid arthritis, these are conditions in which our body's own immune system attacks our own cells.
• Uremia, a complication of untreated kidney failure .
• Severe thyroid hormone deficiency (Severe hypothyroidism) .

Factors that increase risk

You are at higher risk of developing pericarditis after certain events.

• After a heart attack: This is also called Dressler's syndrome.
• After open heart surgery: This is called postpericardiotomy syndrome.
• After receiving radiation therapy.
• After other medical treatments, such as cardiac catheterization or radiofrequency ablation (RFA) .

What complications can this cause?

If pericarditis is not treated in time, dangerous complications can occur.

The main one is Pericardial Effusion . Simply put, it is the accumulation of fluid (water) inside the sac around the heart. While a little water is not a big deal, if this fluid builds up quickly, it can lead to a very serious condition called Cardiac Tamponade .

That's why it's so important to see a doctor as soon as you experience symptoms of pericarditis. If you start treatment early, you can prevent these serious complications from developing.

Doctor, how do you diagnose this?

When you go to see your doctor, he will first ask about your symptoms and whether you have had any recent illnesses. Then he will put a stethoscope to your chest and examine it.

With pericarditis, the inflamed membranes rub together as the heart beats, making a grating sound, like two leaves being rubbed together. Doctors call this a “pericardial rub.” If you hear this sound, it is a strong indication that you have pericarditis.

In addition, to confirm the diagnosis and check for complications, your doctor may suggest several tests like these.

What are the treatments for pericarditis?

It is often treated with medications and physical activity restrictions, but in severe cases, dehydration or surgery may be necessary.

Medication

Many people get relief from these medications.

• NSAIDs: Painkillers and anti-inflammatory medications, such as ibuprofen or high-dose aspirin.
• Colchicine: This is also a type of medication that reduces inflammation. Your doctor may prescribe this if your symptoms have been present for more than two weeks or if the condition is recurring.
• Prednisone: This is a type of steroid. This may be given if other medications don't work for you.
• Antibiotic or Antifungal Medication: If your illness is caused by a bacterial or fungal infection, you will be given the appropriate antibiotics.

Physical activity restriction and rest

Rest is essential while recovering from pericarditis. If you exercise, run, or do other strenuous activities, they can make the inflammation worse. Therefore, your doctor will tell you exactly how long and to what extent you should limit physical activity. It is very important to follow these instructions exactly.

Fluid drainage

If a condition like Cardiac Tamponade, which we talked about earlier, occurs, that is, if the heart is filled with water and the heart is blocked, that extra fluid has to be removed.

• Pericardiocentesis: This involves inserting a long, thin tube (catheter) through the chest and removing fluid that has accumulated in the sac around the heart.
• Pericardial window: If the fluid cannot be removed with a needle, a small incision is made in the chest, a small opening is made in the sac around the heart, and the fluid is allowed to drain through it.

Surgery

If you have a severe condition like Constrictive Pericarditis, you may need to undergo a surgery called Pericardiectomy , which is the surgical removal of part of the thickened sac that surrounds the heart.

What's next? What can we expect?

You will need to rest for a while while you recover from pericarditis. Once you are fully recovered, you can resume your normal activities. But don't go back to strenuous exercise until your doctor says, "Okay, it's okay now."

The good news is that with timely treatment, most people recover completely . Some mild cases can even get better with rest. But if left untreated, it can become chronic.

Between 15% and 30% of people with pericarditis will have recurrent episodes over the years. Therefore, it is very important to take the medication your doctor prescribes and to keep up with follow-up appointments.

Pericarditis, chest pain, heart disease, heart attack, pericardial effusion, cardiac tamponade, shortness of breath