Introduction
The term "pericardial disease" describes a collection of disorders affecting the pericardium. The heart is enveloped in a double-layered sac called the pericardium. This sac prevents the heart from enlarging when blood volume is high and protects the heart from infection. The pericardium normally has precisely the right amount of lubricant between its two layers to allow them to glide over one another with ease. The two layers are hardly separated. But under some conditions, excess fluid builds up in this area, known as the pericardial space, and it expands. Rarely, people may be born with congenital heart abnormalities or without a pericardium, which increases the chance of a herniation with potentially fatal consequences. Frequently, surgery is required to fix these flaws or, if it is not feasible, to remove the entire pericardium. Various disorders, including inflammation (pericarditis), may arise from infections, injuries, drugs, or cancer spread. Pericarditis can manifest acutely, subacutely, or chronically. At the same time, other conditions such as pericardial effusion, constrictive pericarditis, and fibrosis further contribute to the spectrum of pericardial diseases, necessitating diverse diagnostic and therapeutic strategies.
What Is the Pericardium?
The thin, two-layered pericardium is a fibroelastic sac that divides the heart from the surrounding mediastinal tissues. The fibrous pericardium, which is the outermost layer of the pericardium, is often thinner than two millimeters. The serous pericardium is a two-layered sac that makes up the interior part of the pericardium. The outer parietal pericardium, which borders the fibrous sac, is formed by reflection of the visceral pericardium, also known as the epicardium, which is firmly attached to the underlying myocardium. The pericardial cavity, which sits between the two layers of the serous pericardium, usually holds up to 50 milliliters of pericardial fluid. Despite not being essential to life, the pericardium performs vital roles such as protecting against infection and inflammation and maintaining the location of the heart within the chest.
What Are the Types of Pericarditis?
Types of Pericarditis:
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Acute Pericarditis: Sudden development of pericardial inflammation accompanied by the abrupt start of symptoms.
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Chronic Pericarditis: Pericardial inflammation that persists for three months or more following an acute episode of chronic pericarditis.
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Constrictive Pericarditis: A severe kind of pericarditis in which the pericardium's inflammatory layers stiffen, thicken, develop scar tissue, and adhere to one another. The natural function of the heart is interfered with by constrictive pericarditis. This usually happens following several bouts of acute pericarditis over time.
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Infectious Pericarditis: A bacterial, fungal, viral, or parasitic infection can cause infectious pericarditis.
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Idiopathic Pericarditis: Unknown-cause pericarditis is referred to as idiopathic pericarditis.
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Traumatic Pericarditis: Damage to the chest, such as that sustained in an automobile collision, can result in traumatic pericarditis.
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Uremic Pericarditis: Kidney failure can lead to the development of uremic pericarditis.
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Malignant Pericarditis: Arises when a cancerous growth grows within the body.
What Is Constrictive Pericarditis?
The thin membrane that surrounds the heart, which is known as the pericardium, might thicken and stiffen more than usual in constrictive pericarditis. This impairs the heart's capacity to pump blood, which can result in serious issues including heart failure. Although it is typically a chronic (long-term) issue, most instances may be treated, particularly with an early diagnosis. The pericardium is elastic and flexible in normal conditions. This indicates that the heart expands easily to fill with blood in between heartbeats. Constrictive pericarditis causes the pericardium to become thicker and more rigid than usual. It prevents the heart from expanding as it ought to. The heart finds it difficult to pump enough blood to meet the body's demands when it is unable to expand sufficiently to fill with blood. To compensate, the filling pressures increase, which leads to heart failure. Overall, constrictive pericarditis is an uncommon disorder. About nine percent of patients with acute pericarditis experience it and acute pericarditis accounts for about five percent of all chest pain-related emergency room visits.
What Are the Symptoms of Pericarditis?
Pericarditis symptoms include severe, stabbing chest discomfort that gets worse when one coughs, swallows, breathes deeply, or lays flat. An upright, forward-leaning position provides relief. Other symptoms include discomfort in the neck, back, or left shoulder; dyspnea while lying down; palpitations; worry; exhaustion; and fever. In severe instances, there may be lower extremity edema, which would suggest constrictive pericarditis. This advanced variety causes the pericardium to stiffen, which prevents the heart muscle from expanding and causes blood to pool in the legs, abdomen, and lungs. As a result, congestive heart failure symptoms such as edema and irregular heart rhythms appear.
What Causes Pericarditis?
In up to 90 percent of cases, Idiopathic pericarditis is the term used to describe pericarditis for which the origin is unknown. Pericarditis can be caused by several different things, including bacterial infections (like tuberculosis) or viral infections (especially gastrointestinal viruses), which can result in bacterial or viral pericarditis. Among the various causes are fungal or parasitic infections, autoimmune diseases such as rheumatoid arthritis and lupus, traumatic chest injuries such as those sustained in car accidents, kidney failure leading to uremic pericarditis, tumors such as lymphomas causing malignant pericarditis, and genetic conditions such as familial Mediterranean fever (FMF). Furthermore, post-heart attack, open heart surgery, and specific medical treatments such as radiation therapy, cardiac catheterization, or radiofrequency ablation (RFA) are associated with an increased risk of pericarditis. Pericardial inflammation in these cases is frequently an abnormal reaction to the procedure or disease, and symptoms may not appear for weeks following bypass surgery.
How Is Pericarditis Diagnosed?
An echocardiography (echo) to evaluate heart function and identify pericardial effusion, an electrocardiogram (ECG or EKG) to detect abnormalities in heart rhythm, and a chest X-ray to measure lung fluid and heart size are some of the procedures that may be required. By using gadolinium as a contrast agent, cardiac magnetic resonance imaging (MRI) provides a comprehensive analysis of pericardial fluid, inflammation, and heart compression. Iodine dye-enhanced CT scans are essential for identifying malignancies, inflammation, fluid, calcium, and heat-related illnesses. Cardiac catheterization confirms the diagnosis of constrictive pericarditis and provides information on heart-filling pressures. Blood tests play a crucial role in diagnosing pericarditis, evaluating heart function, ruling out heart attacks, and examining pericardial fluid. Inflammation is frequently indicated by elevated sedimentation rate (ESR) and C-reactive protein levels.
How Is Pericarditis Treated?
A major determinant of the treatment approach is the severity of the ailment; minor instances sometimes resolve on their own without medical assistance. Treatment may involve a combination of the following modalities: pericardiocentesis to remove excess fluid from the pericardial cavity, anti-inflammatory medications to reduce inflammation and symptoms of chest pain associated with pericarditis, and pericardiectomy for severe chronic cases of pericarditis where the pericardium obstructs optimal cardiac function. The removal of the entire pericardium becomes essential in such instances to ensure the heart can pump effectively.
Conclusion
Pericarditis presents varied causes and symptoms, necessitating careful diagnostic procedures. Treatment strategies, ranging from medications to surgical interventions, are determined based on the underlying factors and severity. Prompt and tailored therapy is necessary to effectively manage pericarditis and avoid possible consequences.
