As varied as the possible causes of pericarditis or pericarditis are, so are the respective treatment options. With usually good chances of cure, prevention is difficult.
What is pericarditis?
The pericardium is a tissue envelope that surrounds the heart. This tissue envelope is also called the pericardium. In medicine, pericarditis is therefore also referred to as pericarditis. Symptomatically, pericarditis becomes noticeable in the affected person, for example, through severe pain below the sternum. This pain often intensifies during physical exercise or deep breathing. In addition to pain, pericarditis can also lead to fever. A distinction can be made between so-called primary pericarditis and secondary pericarditis. The more common primary and the less common secondary pericarditis differ, among other things, in their underlying causes. In many cases, pericarditis can be accompanied by a so-called pericardial effusion. This involves an accumulation of fluid in the pericardium.
Causes
There are several causes that can underlie pericarditis. While primary pericarditis is most often caused by viruses (and in rarer cases by bacteria), diseases that do not primarily affect the heart are responsible for secondary pericarditis. If no clear cause can be assigned to a pericarditis, this is also referred to in medicine as idiopathic pericarditis. Viral pericarditis is often caused by Coxsackie viruses. However, influenza viruses or adenoviruses can also be responsible for pericarditis. Bacteria that lead to pericarditis often originate from sites of inflammation in the body and are transported to the heart via the blood. Finally, secondary pericarditis can result, for example, from various cancers that metastasize to the pericardium.
Symptoms, complaints, and signs
Acute pericarditis is most often noticeable by pain in the chest and behind the breastbone, often radiating to the left arm, neck, or back, and can be made worse by coughing, breathing, swallowing, or when the position of the body is changed. Sometimes the symptoms may improve if the affected person sits upright and bends the upper body forward. Fever is also possible. Other symptoms may include an acceleration of the heartbeat and cardiac arrhythmias. In a severe course, chest tightness and shortness of breath may also be present. Since similar symptoms can also be signs of a heart attack or inflammation of the lungs or pleura, a doctor should be consulted immediately and the cause clarified. In the case of chronic pericarditis, it is possible that no or hardly any symptoms occur or that they develop so slowly that they are overlooked for a long time. Affected individuals then initially feel only a general lassitude, and symptoms such as an acceleration of the heartbeat, congestion of the neck veins, initially discomfort during physical exertion, later also at rest, and the formation of edema develop only as the disease progresses.
Diagnosis and course
To diagnose pericarditis, the attending physician usually first interviews the patient about his or her medical history and performs a physical examination with a stethoscope. If pericarditis is suspected, an ECG may be performed and blood drawn (the latter to obtain evidence of inflammation). In most cases, pericarditis takes a good healing course. Especially if the pericarditis is viral, healing often occurs after a few weeks. In some cases, however, complications can arise, for example if the pericarditis spreads to other structures of the heart. Another complication is pericardial tamponade, for example. In this case, the pressure of the pericardium on the atria becomes so high that blood pressure drops sharply.
Complications
Acute pericarditis usually heals without complications if treated properly.However, if pericarditis remains untreated, life-threatening heart problems can develop. First, there is a risk that the inflammation will spread to other layers of the heart and lead to myocarditis or pericarditis. Pericardial tamponade can also develop. In this case, fluid accumulates in the pericardium and presses on the heart, leading to cardiogenic shock in extreme cases. On a permanent basis, such pericardial effusion can cause other diseases and symptoms, such as bleeding or right heart failure. Chronic inflammation of the pericardium can lead to what is known as “armored heart,” in which the pericardium hardens like a capsule and calcifies. In the long term, an armored heart can lead to permanent heart damage and severely impair the heart’s pumping function. In addition, permanent congestion-related kidney or liver damage can occur, which is associated with further complications. For example, a swollen liver can lead to swelling of the legs and fluid accumulation in the abdominal cavity. A damaged kidney can cause high blood pressure, poisoning and other symptoms. In addition, those affected are usually severely fatigued and suffer from various accompanying symptoms.
When should you go to the doctor?
One should definitely see a doctor immediately if physical symptoms such as pain on the left side of the chest and behind the breastbone occur during an infection, especially if there is a simultaneous feeling of weakness. Particularly with bacterial infections or in people with autoimmune diseases, there is an increased susceptibility to pericarditis. But even if there is no infection, symptoms that may indicate heart problems should always be taken seriously and in any case be clarified by a doctor. Anyone who is quickly exhausted, tends to run a fever repeatedly and suffers from frequent heart palpitations should seek medical treatment immediately, because untreated heart disease can be life-threatening. The earlier treatment begins, the better the chances of recovery. If a flu-like infection with fever causes pain behind the breastbone and shortness of breath, and the circulation is so unstable that circulatory collapse is imminent, an emergency physician must be called immediately. In addition, in case of shortness of breath and a suspected heart attack, first aid must be administered until the arrival of the emergency physician and ambulance.
Treatment and therapy
For successful therapy of pericarditis, among other things, the diagnosis of appropriate causes is important in order to be able to treat any underlying diseases as well. Regardless of the cause, however, physical rest through bed rest is usually necessary initially for pericarditis. While in many cases pericarditis can be treated with medication, in some cases surgery is necessary. If pericarditis is caused by viruses, the options for drug therapy include the administration of anti-inflammatory and pain-reducing drugs. In this case, mainly symptom control is possible. If bacteria are behind pericarditis, they can also be combated with antibiotics. If, for example, an autoimmune disease underlies secondary pericarditis, therapy can integrate immunosuppressive drugs. If kidney failure is responsible for pericarditis, dialysis may be necessary in addition to drug treatment. If pericarditis results in pericardial tamponade, for example, a possible surgical measure called pericardiocentesis is necessary. This involves draining the fluid from the pericardium that is pressing on the heart chambers. If the fluid builds up quickly, the procedure may also require placement of a cardiac catheter to continuously drain the fluid from the pericardium.
Outlook and prognosis
Pericarditis can result in the premature death of the affected person without medical care. The inflammation can spread further in the organism to the surrounding areas and lead to a steady deterioration of health. The functional activity of the heart is considerably reduced and can lead to irregularities as well as failures. In the case of an unfavorable course, there is a threat of an acute health condition that can trigger lifelong health impairments or lead to the death of the affected person.Often, an acute condition requires surgical intervention to stabilize the patient. Subsequently, rehabilitation measures as well as restructuring of lifestyle habits must be carried out, as the general performance of the affected person is reduced. With early and good treatment, the prognosis is favorable. With medical care and good treatment options, pericarditis heals completely in most patients. If no complications occur, the patient can usually be discharged from treatment after a few weeks as symptom-free. Drug therapy prevents the pathogens from spreading and at the same time kills them. The stronger and healthier the patient’s own immune system is, the faster a cure is possible. If other diseases are present or if cardiac activity is impaired overall, recovery may be delayed. Nevertheless, a cure is possible.
Prevention
There are few ways to prevent pericarditis. If a patient is affected by repeated pericarditis to which no cause can be assigned, administration of a prophylactic drug is occasionally possible in consultation with the attending physician.
Follow-up
The determining factor for treatment, and therefore follow-up care, for pericarditis is the cause of it. For viral pericarditis, the pain medications and anti-inflammatories prescribed by the physician should be taken in the recommended amount and duration. If another underlying disease is causative for pericarditis, its treatment is also required. In chronic pericarditis, it is important to be aware of the symptoms so that prompt action can be taken when the first signs appear. In addition, a regular cardiological examination should be performed. In principle, prevention of infection is advisable for all forms of pericarditis. General hygiene measures, vaccinations if necessary, and avoidance of further infection risks should always be considered here. It is particularly important to refrain from any physical exertion or sporting activity during the healing process. Sport and heavy physical work should only be taken up slowly after the pericarditis has completely subsided and, if necessary, should be suspended again if symptoms recur. Other activities that place a heavy strain on the heart, such as fatty foods, smoking and a generally unhealthy lifestyle, should also be recognized as risk factors and discontinued if possible. Regular cardiac examinations should be performed.
Here’s what you can do yourself
Individuals diagnosed with pericarditis can support medical treatment with some measures and various household and natural remedies. Above all, bed rest is important, because only by taking it easy can recovery proceed optionally and without complications. Affected persons should also eat a healthy diet, avoid stress and pay attention to regular but moderate physical exercise. Drug therapy can be supported by natural remedies. In addition to herbal tea made from chamomile or lemon balm, gentle preparations made from valerian are also an option. However, in case of severe pain in the area of the heart, the doctor should be consulted. In general, pericarditis requires medical monitoring, especially if there are pre-existing conditions and other risk factors. However, certain home remedies such as warm compresses or compresses may be used in most cases. After consultation with the doctor, various remedies from the field of homeopathy can be tried. For example, the remedy Kalium carbonicum or also “potash” has proven itself. In case of stabbing chest pain Asclepias tuberosa or Kalmia help. If the pericarditis does not subside despite all measures, further medical examination is necessary.
