Pericarditis Lesson

What is pericarditis?

Pericarditis is the inflammation of the pericardium.

The two layers of pericardium that gets affected with pericarditis is the parietal and visceral. The pericardial cavity is normally filled with small amounts of fluid to reduce friction. There is a potential chance that the space between these two layers can become filled with excess amounts of fluids. This is when an inflammation has occured. Pericardium is a loose fitting double-layered sac that encloses the heart and the proximal portions of the vessels attached to its base.

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Who is most at risk?

Pericarditis affects everyone of all ages but is most common among men between the ages of 20-50 year olds.

Signs and Symptoms

  • sharp and stabbing pain due to heart rubbing against pericardium
  • difficult breathing when lying down
  • dry coughs
  • pain in the back, neck or left shoulder
  • anxiety and fatigue

How is pericarditis diagnosed?

The signs and symptoms provide significant clues to help diagnose pericarditis. To diagnose pericarditis, doctors will take a look at previous medical records and will ask questions involving your symptoms. The doctor will then do a physical exam and take a look at the sound of your heart to test if you may possible have this disorder.


When listening to the heart, the doctor will use a stethoscope to check for a particular sound, which are made when the pericardial layers rub against each other. This sound is called a pericardial rub.


The next possible step is to undergo one of these diagnostic procedures:


· Echocardiography: Echocardiography is often used for chronic pericarditis to conform the diagnosis. This test uses high-frequency sound waves to create an image of your heart and its structure. This machine also has the ability to detect the amount of fluids in the pericardial cavity.


· Electrocardiogram (ECG): This test has wires hooked up to your body to measure the electrical impulses given off by the heart.

These are ways to recognize pericarditis on a ECG:

1. Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).

2. Reciprocal ST depression and PR elevation in lead aVR (± V1).


· Chest x-ray: Doctors can study the heart by examining the shape and size of the heart. If the heart is enlarged then it may indicate excess fluid has accumulated in the pericardial cavity.


· Cardiac magnetic resonance imaging (MRI): This machine uses a magnetic field and radio waves that can reveal thickening, inflammation or other changes in the pericardium.


· Computerized tomography (CT): This is an x-ray machine that can be used to look for thickening of the pericardium.

What triggers pericarditis?

Pericarditis can be acute (develops suddenly, doesn't take long to treat) as well as chronic (develops over time, takes a long time to treat). Acute pericarditis and chronic pericarditis both cause inflammation of the pericardium.

Acute Pericarditis Triggers:


  • bacterial, fungal, or viral infection
  • rheumatic fever
  • rheumatoid arthritis
  • systemic lupus
  • kidney failure
  • scleroderma
  • cancer
  • heart attack
  • heart surgery
  • serious chest injury
  • certain medications that suppress the immune system

Chronic Pericarditis Triggers:

  • chronic infection
  • tuberculosis

First Aid Care For Disorder:

If you notice someone experiencing symptoms of pericarditis, you should call 911 immediately to take them to the hospital. While waiting for the ambulance, they should sit up and lean forward to help relieve the pain. They should also bend over or hold their chest to be able to breathe more comfortably.

Preventative Steps:

Most of the time, acute pericarditis cannot be prevented. You can only reduce the chances of getting it again or having it develop into chronic pericarditis.

Preventative Steps:

  • prompt and effective treatment
  • follow the treatment plan exactly as ordered
  • ongoing medical care
  • listen and follow your doctor's advice
  • rest

Treatment Methods:

When treating a patient, the main goals are:


  • reducing pain and inflammation
  • treating the cause (if known)
  • checking for other complications

The first thing your doctor will do is prescribe you an anti-inflammatory medication (such as aspirin and ibuprofen) to reduce pain and inflammation. If pain is severe, they may prescribe a stronger medication such as colchicine and a steroid called prednisone. If the pericarditis was caused by an infection, they may prescribe an antibiotic. In some cases, you will need to stay at the hospital so that your doctor can check for complications.


If cardiac tamponade (compression of the heart) occurs, it will be treated by a procedure called pericardiocentesis. This procedure involves a needle or tube inserted into the chest wall to remove the excess fluid in the pericardium caused by the inflammation. This relieves the pressure that was on the heart.

Constrictive pericarditis (chronic, muscle tightening around heart) can only be treated with a surgery called pericardiectomy to remove the pericardium.

Prognosis

Pericardium can be a mild illness or critical disorder. If pericardium is treated immediately then there would be a positive outcome for this condition. Depending on the person it could take 2 weeks to 3 months to recover. However, there is a possibility that it could reoccur again after being treated. This is called chronic.


If the disorder was severe then constrictive pericarditis will occur and can cause long-term problems that are similar to those who have experience heart failure. Constrictive pericarditis is the long-term inflammation of the pericardium. Which causes scarring and thickening of the pericardium and muscle tightening. Over time, the pericardium loses its elasticity and becomes rigid. This is a serious health issue.


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Pericarditis