Pericarditis
Pericarditis is the inflammation and irritation of the pericardium, the protective two-layered sac surrounding the heart. This condition often results in sharp chest pain, which may worsen with deep breathing or lying flat but can ease when sitting upright. The inflammation may lead to complications such as cardiac tamponade, where excess fluid compresses the heart, and constrictive pericarditis, characterized by scarring of the pericardial sac. Pericarditis is commonly caused by viral infections, but can also arise from bacterial infections, cancer, chest trauma, autoimmune diseases, and other factors. Although anyone can develop it, it is most frequently observed in men aged 20 to 50 and in young children when bacterial infections are involved.
Diagnosis typically involves assessing symptoms, physical examinations, and imaging tests to detect fluid buildup. Treatment is tailored to the underlying cause, with viral cases often resolving on their own within weeks, while bacterial infections may require antibiotics. Complications from untreated pericarditis can be serious, emphasizing the importance of timely medical intervention. Recent studies have also explored the rare occurrences of pericarditis following COVID-19 vaccinations, particularly in young adult males, indicating that while the condition can arise, recovery is generally swift with appropriate treatment.
Pericarditis
- ANATOMY OR SYSTEM AFFECTED: Cardiovascular system, heart
Definition
Pericarditis is the irritation and swelling of the pericardium, the two-layered sac that envelops the heart. Pain is caused when the inflamed layers rub together or against the heart. The inflammation may, in turn, cause fluids to build up within the sac. Complications include cardiac tamponade (excessive fluid buildup that squeezes the heart) and constrictive pericarditis (scarring and stiffening of the pericardial sac).
Causes
Most often, pericarditis is caused by a viral infection such as influenza, meningitis, mumps, infectious mononucleosis, intestinal tract disorder, or complications from acquired immunodeficiency syndrome. Bacterial pneumonia, meningitis, or influenza; other bacterial infections such as empyema, tuberculosis, or skin and wound diseases; and fungal infections can also spread to the pericardium and cause inflammation. Pericarditis may also be related to cancer, chest trauma (including surgery), kidney failure, autoimmune disease, and radiation therapy. Often, the cause is unknown.
Risk Factors
Anyone can develop pericarditis; however, the condition is most common in men aged twenty to fifty years. Children younger than four years of age are more apt to develop bacterial pericarditis. Within the general population of the United States, pericarditis affects 28 out of every 100,000 individuals. After an acute episode, 15 to 30 percent of people will have a recurrence; some will develop chronic pericarditis.
After the development of the COVID-19 vaccine, the Centers for Disease Control began monitoring reports of cases of pericarditis occurring following vaccination. The CDC continues actively studying the relationship between the COVID-19 vaccination and pericarditis. Though rare, when these cases have been reported, they have occurred within several days of the patient receiving the second dose of the mRNA COVID-19 vaccine. The cases were most prevalent in young adult males, and the patients responded well to medical intervention, allowing them to recover quickly. The incidence was even less with the COVID booster shot. Health officials continued to urge people to receive a COVID vaccine, as the benefits outweighed the risks.
Symptoms
Pericarditis caused by a virus typically comes on suddenly and is short-lived, whereas bacterial pericarditis may develop gradually. Sharp chest pain is the most common symptom, although some people report dull pain or pressure; chronic episodes can be painless. The neck, left shoulder, back, and abdomen may also be affected, and pain may worsen with deep breathing and coughing or when lying flat; the pain may ease when sitting upright or bending forward. Shortness of breath is also common, as is a dry cough, fatigue, an increased heart rate, and a fever. In cases of constrictive pericarditis, the legs and ankles may swell; with cardiac tamponade, blood pressure levels may drop.
Screening and Diagnosis
The affected person’s symptoms, especially from any recent flu-like infections, are important in the diagnosis. During the physical examination, the clinician will use a stethoscope to listen for the scratchy sound of the pericardium rubbing against the heart and for other signs of fluid buildup. A chest radiograph, echocardiogram, and computed tomography scan can confirm fluid buildup or other signs of pericardial damage. Cultures of the blood and pericardial fluid can detect bacterial or fungal infections.
Treatment and Therapy
Treatment generally depends on the underlying cause. Pericarditis caused by a virus usually resolves within three weeks; affected persons are advised to rest and are given medications to relieve pain and reduce inflammation. Persons who do not respond to this regimen may be given corticosteroids or colchicine. Antibiotics or antifungal medications are also prescribed for bacterial pericarditis. Those with fluid buildup or other complications are typically hospitalized for observation and further testing. Fluids may be drained from the pericardial sac, which requires a local anesthetic. For persons with chronic or constrictive pericarditis, part or all of the pericardium may be surgically removed.
Prevention and Outcomes
Untreated bacterial pericarditis can be life-threatening. Prompt medical treatment and follow-up can help to prevent complications or a second attack.
Bibliography
Heidecker, Bettina, et al. "Myocarditis Following COVID‐19 Vaccine: Incidence, Presentation, Diagnosis, Pathophysiology, Therapy, and Outcomes Put into Perspective. A Clinical Consensus Document Supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases." European Journal of Heart Failure, 2022, p. 10.1002/ejhf.2669, doi.org/10.1002/ejhf.2669. Accessed 21 Nov. 2024.
Hoit, Brian D. "Acute Pericarditis." Merck Manual Consumer Version, May 2024, www.merckmanuals.com/home/heart-and-blood-vessel-disorders/pericardial-disease/acute-pericarditis. Accessed 21 Nov. 2024.
“Coronavirus Disease 2019 (COVID-19) Vaccine Safety.” Centers for Disease Control and Prevention, 30 Oct. 2024, www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html. Accessed 21 Nov. 2024.
“Pericarditis.” Cedars-Sinai, www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericarditis.html. Accessed 21 Nov. 2024.
"Pericarditis." MedlinePlus, US National Library of Medicine, 27 Feb. 2024, medlineplus.gov/ency/article/000182.htm. Accessed 21 Nov. 2024.
Spodick, David H. The Pericardium: A Comprehensive Textbook. Marcel Dekker, 1997.
“Recurrent Pericarditis.” National Organization for Rare Disorders, 9 Nov. 2021, rarediseases.org/rare-diseases/recurrent-pericarditis. Accessed 12 Nov. 2024.
"Pericarditis Guide." Cleveland Clinic, my.clevelandclinic.org/documents/heart/pericarditis‗treatment‗guide.pdf. Accessed 21 Nov. 2024.
"What Is Pericarditis?" American Heart Association, 6 June 2024, www.heart.org/en/health-topics/pericarditis/what-is-pericarditis. Accessed 21 Nov. 2024.
Zipes, Douglas P., et al., editors. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed., Philadelphia: Saunders/Elsevier, 2005.