Acute pericarditis

Acute pericarditis is an inflammation of the pericardium, the fibrous sac surrounding the heart. This condition can cause sharp chest pain and other symptoms, and may lead to complications if not properly managed. Acute pericarditis is most commonly caused by viral infections, but can also result from bacterial infections, autoimmune diseases, myocardial infarction (heart attack), and other medical conditions.

Causes

The etiology of acute pericarditis is diverse, with viral infections being the most common cause. Coxsackievirus, echovirus, and adenovirus are examples of viruses that can lead to this condition. Bacterial pericarditis, though less common, is more severe and is often caused by organisms such as Staphylococcus aureus and Mycobacterium tuberculosis in the setting of tuberculosis. Other causes include systemic diseases like lupus erythematosus, rheumatoid arthritis, and kidney failure; metabolic disorders such as uremia; and physical injury to the chest or heart surgery.

Symptoms

Patients with acute pericarditis typically present with sharp, stabbing chest pain that may radiate to the neck, shoulders, or back. The pain often worsens when lying down or taking deep breaths and may improve when sitting up and leaning forward. Other symptoms can include fever, a pericardial friction rub (a scratchy sound heard with a stethoscope), shortness of breath, and general malaise.

Diagnosis

Diagnosis of acute pericarditis involves a combination of clinical history, physical examination, and diagnostic tests. Key diagnostic criteria include chest pain characteristic of pericarditis, pericardial friction rub, and changes in the electrocardiogram (ECG) indicative of pericarditis. Additional tests may include echocardiography to assess for pericardial effusion (fluid in the pericardial space), blood tests to identify inflammatory markers and potential causative agents, and imaging studies like CT scan or MRI to evaluate the pericardium's condition.

Treatment

Treatment of acute pericarditis focuses on relieving symptoms and addressing the underlying cause. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation. In cases where NSAIDs are ineffective or contraindicated, colchicine may be prescribed to decrease inflammation. For bacterial pericarditis, antibiotics are necessary. Corticosteroids are reserved for severe cases or those not responding to first-line treatments, particularly in patients with underlying autoimmune conditions. In cases of significant pericardial effusion or cardiac tamponade, a surgical procedure called pericardiocentesis may be required to remove the excess fluid.

Complications

If left untreated, acute pericarditis can lead to complications such as cardiac tamponade, a life-threatening condition where fluid accumulation in the pericardial sac exerts pressure on the heart, impairing its ability to pump blood. Another potential complication is constrictive pericarditis, a chronic condition where the pericardium becomes thickened and scarred, leading to restricted heart function.

Prevention

Prevention of acute pericarditis largely depends on addressing the underlying causes. This may include vaccination against causative viral agents, timely treatment of bacterial infections, and management of underlying autoimmune or systemic diseases.

See also

• Myocarditis
• Endocarditis
• Pericardial effusion