Symptoms

Acute pericarditis triggers stabbing chest pain. The pain usually occurs as a function of breathing, i.e. there is a stabbing pain in the chest with every breath. In addition to breathing, the pain can also be intensified by coughing or swallowing.

This pain is classically caused by dry pericarditis, in which the inflamed leaves of the pericardium rub against each other. The pain is typically on the left side of the chest, where the heart is located. The pain may radiate to the upper abdomen and towards the neck and shoulder blade.

In addition to breathing, the pain is also position-dependent. Patients usually feel the least pain when sitting and in a slightly bent position. However, increased pain occurs when lying down.

In addition, fever and increased breathing can be signs of inflammation.If it is a wet pericarditis, in which there is an increased accumulation of fluid between the two pericardial blades, the pain decreases or even disappears completely, since the two blades do not rub painfully against each other due to the fluid. Patients with wet pericarditis are often symptom-free, so that pericarditis often heals unnoticed. More severe symptoms occur when pericardial tamponade is performed.

In this case, symptoms of heart failure such as shortness of breath, reduced exercise tolerance, increased heart rate, drop in blood pressure, fluid retention and sweating occur because the heart can no longer pump enough blood into the body’s circulation. If the pericardial tamponade increases, the symptoms become more severe and there is an increasing clouding of consciousness. This indicates the onset of a circulatory shock.

Diagnosis

At the beginning of the visit to the doctor, the attending doctor first takes a medical history. He asks the patient about his current complaints and other abnormalities. This is followed by a physical examination.

Using a stethoscope, a scraping sound (pericardial rubbing) can be heard above the heart in the case of pericarditis. However, if an effusion has already formed, i.e. a moist inflammation, this noise can no longer be heard. It is therefore only present in dry pericarditis.

The examination is usually followed by an ECG, in which one can usually distinguish between pericarditis and heart attack. In addition, an ultrasound examination of the heart (echocardiography) and a blood sample is taken. Since the symptoms of pericarditis are similar to those of a heart attack, the diagnosis serves, among other things, to differentiate between the two diseases.

The ultrasound examination is inconspicuous in dry inflammation. However, if an effusion has formed, the examination can clearly diagnose a wet pericarditis and determine the extent of the effusion. In addition, statements can be made about the pumping function of the heart.

The analysis of the laboratory results of the blood sample serves above all to distinguish between myocardial infarction and pericarditis, as mentioned above. For diagnostic purposes, a pericardiocentesis can also be performed in the case of a wet pericarditis. The puncture has not only a diagnostic effect, but also a therapeutic one, as it simultaneously relieves the heart.

The puncture can be used to determine whether a bacterial pathogen is responsible for the inflammation, which can then be specifically treated with an antibiotic. A puncture is also performed if a malignant process is feared or if there is a suspicion of a tuberculous or purulent effusion. An x-ray examination is performed if pneumonia is suspected as the cause.

The same applies to suspected tuberculosis and lung tumors. An X-ray shows an effusion of pericarditis as a so-called bocksbeutel-like widening of the heart shadow. In the case of chronic pericarditis, a CT or MRI examination may also be necessary, especially if surgery is imminent.

During the blood test, the parameters troponin and creatine kinase are determined. Since cell damage occurs during a myocardial infarction, both markers are released more frequently and are correspondingly elevated during a heart attack. However, if pericarditis has already spread to the heart muscle, both parameters may also be elevated in pericarditis.

In addition to the troponin and creatine kinase values, inflammation parameters are also determined. These include the C-reactive protein (CRP) and the blood sedimentation rate. If the values are elevated, this is an indication of inflammation in the body, which makes pericarditis more likely. In order to get to the bottom of the cause, one can try to detect a triggering pathogen or certain parameters of an autoimmune disease by means of a blood test.