Are you having chest pain and difficulty breathing? This could be pericarditis!

Have you ever felt a sharp, stabbing pain in the middle of your chest, making it hard to breathe? This can happen even after you've recovered from a common cold or flu. Many people are afraid that this is a heart condition. In fact, it can be an inflammation of the sac that surrounds the heart. Today, we'll talk about this condition in detail called ``pericarditis.''

Do you know what pericarditis is?

Simply put, `Pericarditis` is an inflammation or swelling of the `pericardium`, a very thin, two-layered, fluid-filled sac that surrounds our heart. It is similar to a cut on our skin that causes the area to become red and swollen. The main function of this `pericardium` is to protect the heart and provide it with the necessary lubrication when it beats. Due to this inflammation, sometimes extra fluid can accumulate between the layers of the pericardium. This is called `pericardial effusion`.

Pericarditis usually comes on suddenly. However, it can sometimes last for weeks to months. Usually, the condition resolves within three months, but in some people, it can last for years.

There are several types of pericarditis, right?

Yes, there are different types of `Pericarditis`. Let's see what the main types are:

• Acute Pericarditis: This is the most common type. This inflammation occurs suddenly, with the onset of symptoms.
• Chronic Pericarditis: This is the name given to inflammation that persists for three months or more after the initial acute episode.
• Constrictive Pericarditis: This is a more serious condition. What happens here is that the layers of the pericardium that have been inflamed gradually thicken, scar tissue forms, and sticks together. It is as if the heart is constricting. This greatly interferes with the normal functioning of the heart. This condition often occurs after a long period of `Acute Pericarditis`.
• Infectious Pericarditis: This condition can be caused by a viral, bacterial, fungal, or parasitic infection.
• Idiopathic Pericarditis: Sometimes the cause of this is unknown . That's why it's called this.
• Traumatic Pericarditis: This condition can occur after an injury to the chest, for example after a car accident.
• Uremic Pericarditis: This can occur in people whose kidneys are not working properly.
• Malignant Pericarditis: This condition can also occur due to cancer developing elsewhere in the body.

What is the difference between Myocarditis and Pericarditis?

Both are inflammatory conditions of the heart, but they occur in two places. Myocarditis is an inflammation of the heart muscle. Pericarditis is an inflammation of the sac around the heart, called the pericardium. Both are often caused by a virus. Both can cause chest pain. However, with pericarditis, the chest pain should be relieved when you lean forward. With myocarditis, you will feel more tired and weak.

Who is most likely to develop Pericarditis?

Anyone can develop pericarditis. However, it is most common in men between the ages of 16 and 65. According to statistics, this condition occurs in about 28 out of 100,000 people per year.

What happens to the body when pericarditis occurs?

When you have pericarditis, the membrane around your heart becomes red and swollen. It's like the skin around a cut on your arm or leg swelling. This pericardium is very important. It lubricates the heart, protects it from infections and cancer, and helps keep it in place in the chest. It also stops the heart from getting too big when the blood volume increases. This helps the heart work more efficiently.

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

The main symptom of pericarditis is chest pain. This pain also has several specific characteristics:

• Sharp, stabbing pain (this is caused by the heart rubbing against the swollen pericardium).
• This pain may increase when you cough, swallow, take a deep breath, or lie down.
• However, when you sit down and lean forward, you should feel the pain subside. This is a very important symptom.

Sometimes you may feel the need to lean forward or hold your chest to make it easier to breathe.

There are other symptoms:

• Pain in your back, neck, or left shoulder.
• It's hard to breathe when you're stuck.
• A dry cough.
• Palpitations are a feeling of rapid, irregular heartbeat.
• Constantly feeling anxious and tired.
• Fever.
• In severe cases, swelling of the legs, ankles, and feet.

If your legs, feet, and ankles are swollen, or you have trouble breathing even when doing small activities, it could be a sign of a serious condition called Constrictive Pericarditis. This is when the pericardium thickens and prevents the heart from expanding properly. This prevents the heart from pumping blood properly. This can cause the lungs, abdomen, and legs to fill with blood and swell, similar to symptoms of Congestive Heart Failure. Abnormal heart rhythms can also occur.

If you have any symptoms of `Acute Pericarditis`, see your doctor immediately. If you think your symptoms are an emergency, seek treatment at the nearest hospital.

Why does Pericarditis occur? What are the causes?

Surprisingly, in about 90 out of 100 cases, no specific cause can be found for this ``pericarditis.'' This is called ``idiopathic pericarditis.''

However, there are many other reasons why pericarditis can occur:

• As a complication of a viral infection (often a gastrointestinal virus).
• A bacterial infection, for example, tuberculosis.
• A fungal infection.
• An infection from a parasite.
• Due to some `Autoimmune Diseases`, for example `Lupus`, `Rheumatoid Arthritis`, `Scleroderma`.
• A chest injury, like after a car accident.
• Due to `Kidney Failure`.
• Because of cancers like `Lymphoma`.
• Due to genetic diseases like `Familial Mediterranean Fever (FMF)`.
• Due to some medications that suppress the immune system (this is very rare).

Also, the risk of developing Pericarditis is higher after these things:

• After a `Heart Attack`.
• After open heart surgery (Open Heart Surgery / Postpericardiotomy Syndrome).
• After radiation therapy.
• After certain treatments such as `Cardiac Catheterization` or `Radiofrequency Ablation (RFA)`.

In these cases, pericarditis may be caused by a problem with the way the body responds to the surgery or condition. Sometimes, it can take several weeks for symptoms of pericarditis to appear after bypass surgery. Talk to your surgeon about this.

Doctor, how do you diagnose pericarditis?

Sharp pain in your chest and behind your shoulder blades, especially when you bend forward, and chest pain when you breathe in are the two biggest clues that you may have pericarditis. This can help you figure out if it's not a heart attack. Your doctor will ask you about your symptoms, whether you've been sick recently, any past illnesses, any surgeries you've had, and any other health problems that might increase your risk of developing pericarditis.

The doctor will then listen to your heart. When the swollen layers of the pericardium rub together, you will hear a sound like two leaves rubbing together, or two pieces of dry leather rubbing together . This is called a ``pericardial rub.'' This sound is best heard when you lean forward, hold your breath, and then breathe out slowly. Depending on the severity of the inflammation, you may also hear some ``crackles'' in the lungs. This means that there is fluid in the space around the lungs, or there is extra fluid in the pericardium.

What tests are being done for this?

Doctors will do various tests to check for pericarditis, as well as complications such as pericardial effusion or constrictive pericarditis. You may need to do one or more of the following:

• Chest X-ray: Check the size of the heart and see if there is fluid in the lungs.
• Electrocardiogram (ECG or EKG): Checks for changes in the heart rhythm. About half of people with pericarditis will have some noticeable changes on their ECG. Some people may not have any changes at all.
• Echocardiogram (Echo): To see how well the heart is working and if there is fluid around the heart (pericardial effusion). An echo can show signs of constrictive pericarditis, which is a thickened, tight sac around the heart.
• Cardiac MRI: To check for extra fluid, inflammation, thickening, or heart murmurs in the pericardium . A special substance called `Gadolinium` is injected into the heart.
• CT Scan: To see if there are calcium deposits, fluid, inflammation, tumors, or other diseases in the pericardium. This uses a dye containing `Iodine`. Learn more about inflammation. This test is very important if you need to have surgery for `Constrictive Pericarditis`.
• Cardiac Catheterization: Checks the pressure inside the heart. This can confirm if you have Constrictive Pericarditis.
• Blood Tests: To make sure you don't have a heart attack, to see how well your heart is working, to check the fluid in the pericardium, and to help find the cause of pericarditis. If you have pericarditis, your ESR (Erythrocyte Sedimentation Rate) and ultra-sensitive C-reactive protein (CRP) levels are usually higher than normal. Other tests may also be done to check for autoimmune diseases like lupus and rheumatoid arthritis.

What are the treatments for pericarditis?

In most cases, for people with pericarditis, medication alone is sufficient, depending on the suspected cause. However, if fluid has accumulated in your pericardium, it may need to be removed. If you have constrictive pericarditis, surgery may be necessary.

Medications for Pericarditis

Acute pericarditis is treated with pain and inflammation medications, such as ibuprofen or high-dose aspirin. Depending on the cause of pericarditis, you may need antibiotics or antifungal medications.

If you have severe symptoms for more than two weeks, or if they come back after you've been well, your doctor may also prescribe an anti-inflammatory medication called Colchicine (Colcrys® or Gloperba®). Colchicine can help control inflammation and prevent pericarditis from coming back for weeks or months. If you have kidney disease, your doctor may also prescribe a steroid called Prednisone, which can make it difficult to take ibuprofen and colchicine.

If you have to take high doses of `Ibuprofen`, your doctor will also prescribe other medications to reduce gastrointestinal discomfort. If you are taking high doses of `NSAIDs (Nonsteroidal Anti-inflammatory Drugs)`, you will need to have regular `Follow-up` tests to check for changes in kidney and liver function.

If you have `Chronic` or `Recurrent` Pericarditis, you may need to take `NSAIDs` or `Colchicine` for several years, even if you are otherwise healthy. `Diuretics` ("water pills") usually help to remove the extra fluid that builds up due to `Constrictive Pericarditis`. If you have a heart rhythm problem, your doctor will talk to you about treatment for that.

Your doctor may also talk to you about treating your condition with steroids or other medications, such as `Azathioprine (Azasan® or Imuran®)`, `IV Human Immunoglobulins`, or `Anakinra` or `Rilonacept`.

If your pericarditis is caused by an infection, your doctor will prescribe specific medications to treat that infection. If it is caused by cancer, the best treatment is to treat the cancer.

Surgeries and procedures for pericarditis

When fluid builds up between the layers of the pericardium, it causes a condition called `Pericardial Effusion.` If this fluid builds up quickly, it can cause `Cardiac Tamponade`, a serious condition that puts pressure on the heart and interferes with its function. `Cardiac Tamponade` is a life-threatening medical emergency that requires immediate treatment.

This sudden accumulation of fluid between the layers of the heart can prevent the heart from working properly and cause a drop in blood pressure. This is life-threatening, so a doctor must remove the fluid immediately.

If you have fluid in your pericardial effusion, which is causing pressure on your heart, you may need to have a procedure called pericardiocentesis. This involves the doctor using a long, thin tube called a catheter to remove the excess fluid. This tube and needle are guided into the pericardial sac using either an echocardiogram or a CT scan.

If the fluid cannot be removed with a needle, the doctor will perform a minor surgical procedure called a ``pericardial window.'' This involves making a small incision in the chest and making a hole in the pericardium to remove the fluid.

If you have constrictive pericarditis, part of your heart sac may need to be removed. This surgery is called a pericardiectomy. It is done for people who have scar tissue in the heart sac. It is not usually done for people who have active inflammation and chest pain from pericarditis.

Surgery is not usually used as a treatment for people with recurrent pericarditis, as the inflammation can make it difficult to recover after surgery. However, your doctor may discuss this with you if other treatments have not worked.

How long does it take to recover after treatment?

You should respond to treatment within a week, but you will need to take medication for about two weeks. Recovering from surgery takes longer. It can take weeks or months to fully recover from pericarditis. It is very important to get plenty of rest during that time.

Can pericarditis recurrence be reduced?

Although you can't prevent an episode of `Acute Pericarditis`, you can reduce the risk of it recurring by getting prompt treatment and following the treatment exactly. Also, follow your doctor's instructions about when to resume exercise. Vigorous exercise during active `Pericarditis` can make the condition worse.

What should you keep in mind when living with pericarditis?

Once you have recovered from pericarditis, you should be able to return to your normal activities without any worries. However, do not resume strenuous exercise until your doctor gives you the okay. Your doctor will tell you more about this.

How long does pericarditis last?

• Acute Pericarditis lasts between four and six weeks.
• `Incessant Pericarditis` (continuous) lasts longer than that, but less than three months.
• Chronic Pericarditis has been present for more than three months.
• Between 15% and 30% of people with pericarditis may experience recurring episodes over the years.

If treated, people with `Acute Pericarditis` have a very high chance of recovery. Most people recover completely. If you have a mild case, it may resolve with rest. However, if left untreated, some people can develop `Chronic Pericarditis`.

The most important thing is to take the medications exactly as prescribed by the doctor and to see the doctor on the scheduled dates.

When should you see a doctor?

If you have symptoms of `Constrictive Pericarditis`, see a doctor immediately. These symptoms are:

• Difficulty breathing.
• Swelling of the legs and feet.
• Water retention in the body.
• Palpitations.
• Severe abdominal swelling.

Although chest pain is a common symptom of pericarditis, it can also be a symptom of a heart attack. Therefore, if you experience chest pain, it could be a heart attack, so go to the emergency room immediately.

Finally, some important things

I hope you now have a better understanding of this condition called `pericarditis`. Remember, if you have chest pain, especially when bending forward and pain that increases with breathing, along with symptoms such as fever and fatigue, it could be `pericarditis`. If that happens, it is best not to panic and seek medical advice.

If you get treatment early, you can often make a full recovery. If you follow the treatment properly, it can also help prevent the condition from recurring. Therefore, it is very important to use the medication your doctor prescribes exactly and to go for follow-up visits regularly. Be aware of the symptoms of pericarditis, so that if it does occur again, you can get treatment quickly. I wish you a healthy recovery!

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