The diagnosis of pericarditis is derived from the description of the symptoms as well as the examination of the heart. Before starting treatment, it should be clarified whether pericarditis is due to an unknown cause or whether another disease is the trigger for pericarditis. If this is the case, the cause must be treated to prevent progression of pericarditis.
Diagnosis of pericarditis
The diagnosis of pericarditis is made from the symptoms and examination findings. A rubbing sound is typical on auscultation, although this often disappears as soon as an effusion forms.
Imaging diagnostics used are primarily chest X-ray, electrocardiogram (ECG), and cardiac ultrasound. Ultrasound has the advantage that the accumulation of fluid in the pericardium and its effects on cardiac function can be directly visualized.
For causal research, fluid can be taken from the effusion and checked to see which cells are present: Inflammatory cells, protein, blood components or degenerate cells from cancerous tumors.
Treatment of pericarditis
General measures are used to relieve discomfort and to correct sequelae of the inflammation, such as pericardial effusion.
If a cause is known, it is treated. For example, rheumatic fever is treated with antibiotics and cortisone, and in the case of immune disorders, the body’s own defenses are suppressed. Kidney dysfunction, hypothyroidism or cancer are also addressed with special measures.
Painkillers may be administered for chest pain. In the case of a pronounced pericardial effusion, the excess fluid in the pericardium must be drained via a catheter that is inserted into the pericardium from the front below the costal arch using a long needle. In most cases of acute pericarditis, the inflammatory process heals without consequence after one or more drains of fluid.
Surgery is rarely necessary
Only in the rare case of chronic recurrent pericardial effusion does the pericardium need to be surgically “fenestrated” to allow independent drainage of the inflammatory fluid.
In the rare case of armored heart, the pericardial scarring must be ablated by the cardiac surgeon.
