The pericardium is a relatively avascular fibrous sac that surrounds the heart. It consists of 2 layers: the visceral and parietal pericardium.
- Visceral pericardium : an inner layer that envelopes the entire heart.
- A middle fluid layer to prevent friction between the visceral pericardium and parietal pericardium
- Parietal pericardium :an outer layer made of fibrous tissue an outer layer made of fibrous tissue.
It provides lubrication for the heart, shields the heart from infection and malignancy, and contains the heart in the chest wall. It also keeps the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.
Causes and Risk factors of pericarditis
- Viral infection : enteroviruses,HIV,Glandular fever,Herpes simplex,Cytomegalovirus,Influenza,Hepatitis C
- Fungal infection : histoplasmosis and Candida
- Systemic inflammatory disorders: rheumatoid arthritis or lupus
- Kidney failure
- Radiation therapy
- Under active thyroid gland
- Certain medications.
Type of Pericarditis
- Acute pericarditis: It is most common. It may occur on its own or as a symptom of an underlying disease.
- Chronic effusive pericarditis: Long-term inflammation causes a gradual build-up of fluid within the two layers of the pericardium. In most cases, the reasons for this are unknown. Two of the known causes of chronic effusive pericarditis are tuberculosis and under active thyroid gland( hypothyroidism).
- Recurring (or relapsing) pericarditis: It may be intermittent or constant.
- Delayed pericarditis : pericarditis develops in the weeks after heart surgery or a heart attack.
- Pericardial effusion: It is a buildup of fluid in the pericardium layers.
Symptoms of Pericarditis
The symptoms of pericarditis depend on the type, but may include:
- High temperature
- Sweating and chills
- Breathing problems, such as breathlessness
- Dry cough
- Abnormal heart rhythms, such as accelerated heartbeat (tachycardia)
- Sharp and stabbing chest pains
- Pain radiating into the left shoulder and arm
- pain that is aggravated by lying down or taking deep breaths.
Diagnosis of Pericarditis
- Electrocardiogram (ECG)
- Chest X-ray
- Computerized tomography (CT)
- Cardiac magnetic resonance imaging (MRI)
Treatments of Pericarditis
1)If the cause of pericarditis is an infection:
- Antibiotics will be used for bacterial infections
- Antifungal medicines will be used for fungal pericarditis
2) Other medicines that may be used are:
- Corticosteroids such as prednisone (in some people)
- diuretics to remove excess fluid
3) If cardiac tamponade is present, your doctor may recommend a procedure to relieve fluid buildup, such as
- Pericardiocentesis: In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity.
- Pericardiectomy:If you have constrictive pericarditis, you may need to have some of your pericardium removed. The surgery is called a pericardiectomy.
Complications of Pericarditis
- Constrictive Pericarditis : Scar tissue makes the pericardium stiff and hard, so that the heart is unable to fill properly with blood. This is rare and can develop in people with chronic pericarditis or after heart surgery.
- Cardiac Tamponade: When too much fluid collects in the pericardium, a dangerous condition called cardiac tamponade.