Acute Pericarditis: Causes, Symptoms, Diagnosis, and Treatment

Introduction

Acute pericarditis is an inflammation of the pericardium, the thin sac surrounding the heart. This condition can cause chest pain and other symptoms that may resemble a heart attack. Understanding pericarditis is essential for ensuring timely diagnosis and treatment.

Causes of Acute Pericarditis

Acute pericarditis can be triggered by several factors, including:

• Viral infections (e.g., Coxsackievirus, influenza, HIV, COVID-19)
• Bacterial infections (e.g., tuberculosis, pneumococcus)
• Post-heart attack inflammation (Dressler's syndrome)
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Kidney failure (uremic pericarditis)
• Cancer and radiation therapy
• Chest trauma or surgery

Symptoms

The hallmark symptom of acute pericarditis is sharp, stabbing chest pain, which:

• Worsens when lying down and improves when sitting up
• May radiate to the shoulders or back
• Is sometimes accompanied by fever, fatigue, and difficulty breathing

Other possible signs include:

• Pericardial friction rub (a characteristic sound heard with a stethoscope)
• Pericardial effusion (fluid accumulation around the heart, which can lead to complications)

Diagnosis

To confirm acute pericarditis, doctors use:

• Electrocardiogram (ECG) – Shows characteristic changes (e.g., ST-segment elevation in multiple leads)
• Echocardiogram (Ultrasound of the Heart) – Detects fluid buildup and inflammation
• Chest X-ray and CT/MRI – Helps assess pericardial inflammation and rule out other conditions
• Blood Tests – Look for infection, inflammation markers (C-reactive protein, ESR), and heart damage (troponins)

Treatment

The treatment of acute pericarditis depends on the underlying cause:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen, aspirin) to reduce pain and inflammation
• Colchicine – Helps prevent recurrence
• Corticosteroids – Used only in severe or resistant cases
• Antibiotics or antifungals, if infection is the cause
• Pericardiocentesis (draining fluid from the pericardium) in cases of large pericardial effusion or cardiac tamponade

Possible Complications

• Recurrent pericarditis – Relapse of symptoms after initial treatment
• Cardiac tamponade – Life-threatening compression of the heart due to excessive fluid accumulation
• Constrictive pericarditis – Scarring that restricts heart function

Prevention and Lifestyle Recommendations

• Get vaccinated against common viral infections
• Control underlying conditions such as lupus and kidney disease
• Avoid excessive physical exertion during recovery
• Follow up with your cardiologist for regular monitoring

Conclusion

Acute pericarditis is a manageable condition when diagnosed and treated early. If you experience persistent chest pain, especially pain that improves when sitting up, seek medical attention immediately.

Source recommendations

1. European Society of Cardiology (ESC) Guidelines for Pericardial Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
3. https://pubmed.ncbi.nlm.nih.gov/26320112/
4. https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/2015-esc-guidelines-on-the-diagnosis-and-management-of-pericardial-diseases
5. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases

2. American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Management of Pericardial Diseases

1. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/01/07/10/59/Management-of-Acute-and-Recurrent-Pericarditis
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
3. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases
4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106
5. https://pubmed.ncbi.nlm.nih.gov/33332149/