Pericarditis is an inflammation of the pericardium, which limits the heart to the outside. There are probably 1000 cases per million inhabitants per year, so the disease is not so rare. However, the disease is often not detected because it often proceeds without symptoms and often heals on its own within one to two weeks.
Forms of pericarditis
The pericardium, the pericardium, consists of two leaves – an inner and an outer leaf. There is a small amount of fluid between the two leaves, allowing the two layers to slide against each other without friction. In pericardial inflammation, a distinction is made between a dry form and a moist form.
In the case of dry (fibrinous) pericarditis, both leaves of the pericardium rub against each other without any additional liquid being formed. The dry form often turns into the wet form of pericarditis. In the wet (exudative) form, too much fluid is formed between the two pericardial leaves.
A wet form of pericarditis can also develop into a so-called pericardial tamponade. This is the case when too much fluid accumulates and presses on the heart from the outside so that it is restricted in its pumping function and can no longer fill properly. A pericardial tamponade is a life-threatening condition that is treated acutely by puncturing the fluid in the pericardium.
If a tumor disease is responsible for the development of pericarditis, a so-called hemorrhagic pericarditis can also develop, in which blood accumulates between both leaves of the pericardium. In addition to dry and wet pericarditis, acute pericarditis is also distinguished from a chronic form. Chronic inflammation can lead to scarring or calcification, which can also restrict the heart‘s pumping function. Calcification and scarring cause hardening of the pericardium, which limits the heart’s ability to work. This form of pericardial inflammation is known as pericarditis constrictiva, or figuratively speaking as “armored heart”.
In general, a distinction is made between non-infectious and infectious causes of pericarditis. In more than 50% of cases, the cause of the inflammation remains unexplained, since in most cases a proven cause would not lead to any further consequences for the therapy. Pericarditis of unknown cause is called idiopathic pericarditis.
The most common cause of pericarditis is probably viruses. The main triggers of viral pericarditis are coxsackieviruses, followed by adeno- and echoviruses. In rare cases, bacteria and fungi can also cause infectious pericarditis.
Thus, active tuberculosis can also lead to pericarditis. Autoimmune diseases, which also include rheumatic diseases, play a role as non-infectious causes. Furthermore, a gout disease, kidney failure, tumor disease, as well as a heart attack or the consequence of a heart operation can also be the cause.
Also medicines can release an inflammation of the pericardium. Likewise, irradiation as part of cancer therapy can cause inflammation. In rare cases, “Morbus Still“, a rheumatic disease, can also be the cause.