Viral and Acute Pericarditis - Causes, Types, Symptoms, Diagnosis, and Treatment

Introduction:

Pericarditis is considered acute when the symptoms last less than three months. According to the evidence, it is detected both in males and females with all age groups but frequently in males aged 20 to 30 years. It is observed in roughly 5 percent of patients admitted to the emergency room for chest pains, which initially gives a heart attack differential diagnosis. The recurrence rate is about 30 percent in patients, of to many related and unrelated factors. About three people per 10,000 are affected yearly. And about 30 percent of those affected have more than one episode. However, 85 percent of cases are believed to be because of viruses. Acute pericarditis has several etiologies.

How Does It Happen?

It will be easier to derive this from the cellular to the organ level, but in simpler terms. The pericardium is a sac-like thin tissue that surrounds the heart. It has two layers, an inner layer made of a serous membrane and an outer layer of connective tissue. It acts as a mechanical barrier for the heart and other vessels. The pericardium produces pericardial fluid, which moistens and allows each membrane to glide over each other with each heartbeat. When infection and trauma affect this normal equilibrium, the pericardium is inflamed, causing friction and irritation in the membranes.

What Are the Causes of Acute Pericarditis?

Below are some causes of acute pericarditis:

• Viral infections - Like Coxsackie B virus, HIV (human immunodeficiency virus), influenza, and SARS-CoV-2 (severe acquired respiratory syndrome Coronavirus 2).

• Bacterial infections - Like Lyme disease, staphylococci, streptococci, and tuberculosis.

• Fungal infections - Such as candidiasis and histoplasmosis.

• Certain drugs - Like Penicillin, Phenytoin, and anticoagulants.

• Autoimmune diseases - Systemic lupus and systemic sclerosis.

• Myocardial infarctions and post-myocardial infarction syndrome.

• Inflammatory disorders - Like amyloidosis.

• Trauma.

• Cancer.

• Radiation therapy.

What Are the Signs and Symptoms?

In almost 90 percent of cases, patients present sharp chest pain radiating to the neck, jaw, and arms, imitating a myocardial infarction (heart attack). The pain lasts for hours and may last for days if not approached promptly with treatment. It diminishes by sitting up or bending downward and intensifies when lying supine and taking a deep breath.

Other symptoms may be generalized fatigue, fever, and cough.

What Is the Difference Between Acute Pericarditis and Infarction?

The only difference that can help separate these two from each other is that the pain changes with body positions in pericarditis. In contrast, the pain is usually constant with continuous pressure in infarction.

What Are the Types of Pericarditis?

Yes, there are a few types of pericarditis based on the duration of the symptoms.

1. Acute Pericarditis: Here, the symptoms last less than three months. They may resolve within a week or two. This type develops quickly and often causes a pericardial effusion, the accumulation of fluid in the pericardium that could be blood and serious. They often develop into a subacute or chronic condition. The inflammation can extend to the epicardial myocardium (the outermost layer of the heart). There could be hemodynamic effects, but they are sporadic to be seen. Acute pericarditis can emerge secondary to myocardial infarction.

2. Subacute Pericarditis: Here, the symptoms occur within weeks to months of inciting.

3. Chronic Pericarditis: Here, the symptoms typically persist for more than six months.

4. Recurrent Pericarditis: Here, there are repeated episodes of acute pericarditis.

5. Constrictive Pericarditis: The thin sac surrounding the heart becomes thickened and scarred in this condition. According to studies, 46 % of patients undergo surgical therapy of their previous heart constrictions.

What Tests Can Confirm Acute Pericarditis?

1. Blood tests to check the signs of heart attack and infection.

• Complete blood count and basic metabolic panel.

• Erythrocyte sedimentation rate (ESR).

• Cardiac enzyme levels.

2. Electrocardiography.

3. Chest X-ray.

4. Echocardiography.

5. Doppler studies.

What Is the Treatment of Acute Pericarditis?

Hospitalization is for patients with an initial episode of acute pericarditis. Many patients with high-risk conditions like immunosuppression, oral anticoagulant therapy, or failed to respond to NSAIDs (nonsteroidal anti-inflammatory drugs) are hospitalized while others are treated in outpatient departments.

The main aim of treatment is to focus on treating the underlying cause, avoiding complications, and reducing pain and inflammation.

Acute pericarditis is generally treated with,

• Non-steroidal anti-inflammatory drugs reduce the inflammation of the pericardium. They also relieve lingering pain in patients. No evidence shows that NSAIDs are superior to others for treating pericarditis. However, Aspirin and Ibuprofen are the most common drugs advised.

• Colchicine may be a helpful alternative in patients who cannot take NSAIDs and corticosteroids or have significant side effects. These agents are usually advised to treat recurrent pericarditis, showing a significantly lower recurrence rate. It is also combined with NSAIDs to decrease the rate of recurrence. It is contraindicated in patients with renal impairments.

• Glucocorticoids are not the first-line therapy in patients with acute pericarditis. Patients who do not respond to an NSAID may necessitate a short course of a corticosteroid. They increase the likelihood of recurrent pericarditis. Hence, they are used only in certain complications when the patient has a connective tissue disease and uremia. The most common drug advised is Prednisone.

• Antibiotics are advised when the underlying cause is a bacterial infection.

• Antifungals are advised when the underlying cause is a fungal infection.

Complicated cases may need a pericardiocentesis (removing a small fluid volume around the pericardium), which treats the effusion and corrects the hypotension.

Prognosis:

The outcome is good when it is treated the right way at the right time. Most of the patients recover in a few weeks to three months. However, it can come back if the episodes continue.

Conclusion:

Acute pericarditis cannot be prevented, but chronic pericarditis can. Identifying the signs and symptoms at the earliest without delay, and getting it treated becomes salient to avoid the gradual increase in complications.