The pericardium surrounds the heart and separates it from neighboring structures. Its inflammation is known as pericarditis, which can prevent proper heart function and have dangerous consequences.
Pericarditis is a disease caused by inflammation of the pericardium, a bilayer membrane that surrounds the heart and great vessels like a bag, separating and protecting organs and structures adjacent (lungs, sternum, ribs).
The innermost layer is called the visceral pericardium, and the outermost is called the parietal pericardium. Between them, there is a small amount of fluid called pericardial fluid, which prevents friction between the two layers, allowing them to slide one over the other without friction.
Pericarditis can be classified into acute pericarditis (in which inflammation of the pericardium occurs rapidly) and chronic or constrictive pericarditis (the inflammation of the pericardium is prolonged overtime producing its thickening and calcification, thus turning it into a kind of cuirass that hinders the normal functioning of the heart by preventing adequate relaxation of the heart), the first of them being able to progress towards the second if it does not evolve satisfactorily.
As it is the most frequent, in this article, we will focus mainly on explaining acute pericarditis, finally describing some essential aspects of chronic constrictive pericarditis.
What causes acute pericarditis and which it usually affects
Acute pericarditis predominantly causes chest pain – which is intensified by taking deep breaths or lying down and usually improves when leaning forward – and fever, but not always, and may manifest itself through other symptoms.
Its diagnosis is critical because by affecting the heart, which is a vital organ, there is always the risk of complications that even end the patient’s life. Despite this, the general prognosis of the disease is usually quite good if it is adequately treated.
Acute pericarditis is, as we have said, a disease caused by acute inflammation of the pericardium. It has many causes, the most common being viral or idiopathic pericarditis, which generally appears after developing a respiratory infection.
It affects both men and women, although it is more common in males. It predominates in people between the ages of 20 and 50, although it can also affect children, in whom the Coxsackie virus and the adenovirus most commonly cause it.
There is no curative treatment for acute pericarditis. There is nothing that allows it to end it at its roots, and it is relatively frequent for it to recur. What is done to control the patient is asymptomatic treatment.
In other words, an attempt is made to reduce the inflammation of the pericardium to alleviate the symptoms that the affected person presents. With these therapeutic measures, the disease usually evolves favorably in a few days or weeks in most cases.
Causes of pericarditis
Acute pericarditis can be caused by many triggers, although in most cases, the most common form of acute pericarditis is one in which the cause is not recognized. However, it is considered that viral infections (mainly those that affect the upper respiratory tract, for example, due to a poorly cured cold ) are the most frequent cause of this disease.
There are numerous described causes of acute pericarditis :
Viral or idiopathic: the most common cause of acute pericarditis is one in which the causative agent is not recognized (acute idiopathic pericarditis). However, likely, many of this idiopathic pericarditis is caused by viruses, but their identification is challenging since there are no specific tests that allow their diagnosis.
The viruses that have been most associated with acute pericarditis are the Coxsackie B families (the most common), Echo, Influenza, and adenovirus.
Acute viral pericarditis is characterized by an upper respiratory infection that manifests itself through a flu-like syndrome in the previous weeks. These are added by the inflammation of the pericardium (chest pain, fever, etc.).
This type of pericarditis preferentially affects young men, and it is relatively common for it to recur and reappear (it recurs in up to 25% of cases).
- Bacterial (also known as purulent pericarditis) appears more frequently in people with the altered immune system and has a very high mortality (up to 70% of those affected). A peculiarity of this type of pericarditis is that chest pain is absent in most of those involved, the disease manifesting itself through other symptoms.
- Immune system involvement: acute pericarditis may appear in patients with systemic diseases such as lupus erythematosus, rheumatoid arthritis, different types of vasculitis, leukemias, or hypothyroidism.
- Post-infarction: some patients may develop pericarditis as a complication of myocardial infarction.
- Cardiac Surgery.
- Tumors of different types.
- Physical agents: For example, pericarditis may appear in patients undergoing radiation therapy to treat tumors.
- Injury or trauma to the esophagus, chest, or heart.