Pericarditis, armored heart, pericarditis constrictiva

Our heart is surrounded by a sheath of connective tissue, the pericardium. If it becomes inflamed, this is manifested by stabbing pains in the chest, accompanied by an increased body temperature.

Pericarditis (inflammation of the pericardium) can occur acutely or take a chronic course. The resulting pericardial tamponade is dangerous and can lead to death if left untreated. Mild cases, on the other hand, often go unnoticed and heal without complications.

Overview: What is pericarditis?

The pericardium consists of two layers, the space between which is filled with fluid. This fluid allows the two layers of the pericardium to glide over each other and the heart can expand and contract effortlessly. If these layers become inflamed during pericarditis, the resulting secretion flows into the space between them and can impair the functioning of the heart. Pericarditis is very often triggered by viruses, sometimes also by bacteria. Pericarditis often occurs as a concomitant symptom of other diseases, such as pneumonia or autoimmune or metabolic diseases.

Pericarditis – who is particularly affected?

Most inflammations of the pericardium occur as an unnoticed side effect of a viral infection or tuberculosis. Overall, the risk of developing the disease is higher for men than for women. Few studies have investigated how frequently pericarditis occurs in the population. Experts estimate that there are around 25 to 30 cases per 100,000 inhabitants per year, of which around three have to be treated in hospital. The pericardium can become inflamed in people of any age, although the disease is more common in young adults. People with impaired immune defenses, e.g. after an organ transplant or due to an HIV infection, are particularly at risk.

Causes and risk factors

The causes of pericarditis are varied and cannot be determined exactly in every case. In around half of all cases in industrialized nations, viral infections are responsible for the disease. Pathogens can be flu viruses as well as herpes viruses or HIV. Relatively often, pericarditis occurs as a result of a respiratory infection. Pericarditis can also develop after a heart attack.

In addition to viruses, bacteria can also trigger pericarditis, such as pneumococcal pneumonia. Rare in Switzerland, but common in developing countries, is a connection with tuberculosis (mycobacteria). Bacteria can also enter the bloodstream after tooth extraction and cause pericarditis.

Cancer patients are particularly at risk: In breast or lung cancer and leukemia, metastases can form in the pericardium and cause inflammation there. In rare cases, radiation can also be a cause of pericarditis.

Pericarditis can also occur as part of an autoimmune disease by . the body’s own immune defense is directed against the pericardial tissue, causing inflammation. In the case of kidney disease, toxins can remain in the body, which then lead to pericarditis.

This can manifest itself in worry, tension, circling thoughts or sleep disturbances, among other things, and can complicate the course of treatment. If you or your relatives desire psychiatric-psychological counseling and support, our specialists at the USZ will be happy to assist you.

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Symptoms of pericarditis

Pain in the chest, usually localized under the breastbone, is typical of pericarditis. The pain is usually worse when lying down than when sitting and often radiates to the neck, arms or back. Sufferers often also feel pain when taking a deep breath or coughing. Acute pericarditis is often accompanied by a sudden onset of fever and a rapid pulse. In severe cases, patients also complain of shortness of breath and a feeling of tightness in the chest. However, the symptoms of pericarditis are not always clear. Milder forms can also pass without any particular symptoms.

Pain in chronic pericarditis

The symptoms of chronic pericarditis are less obvious. This can manifest itself in rapid exhaustion and rapid “exhaustion”. Water retention, which often only becomes apparent during a physical examination, is also typical. Because of these barely visible signs, chronic pericarditis is often only recognized when complications arise – such as a pericardial effusion.

Normally there are about 15 milliliters of amber-colored, clear fluid between the two layers of the pericardium. In pericardial effusion, blood or pus from a bacterial inflammation is mixed in. This additional, sluggish fluid means that the heart can no longer work as usual. Sufferers feel less productive and tired.

Diagnosis of pericarditis

To make a diagnosis of pericarditis, we rely on the following:

  • The medical history. A previous respiratory illness or a gastrointestinal infection can be an indication of pericarditis. In addition, the individual medical history with regard to an autoimmune disease is reviewed.
  • Body temperature, blood pressure and pulse as well as the physical examination
  • Heart murmur. We listen to the heart with a stethoscope. One sign of pericarditis is a rubbing noise, acoustically comparable to footsteps on a blanket of snow – the so-called “pericardial rub”.
  • Blood values. A blood test can provide further information: If the blood shows a particularly high number of white blood cells, there is inflammation in the body. In this case, the erythrocyte sedimentation rate is also increased and an increase in the C-reactive protein can be seen. The search for specific antibodies in the blood shows whether an autoimmune reaction to the body’s own tissue could be the cause of the symptoms.

If you have previously traveled abroad, we will also order a tuberculosis test.

Further examinations for pericarditis

If these examinations indicate pericarditis, we will carry out further examinations to confirm the diagnosis. For example:

  • Cardiac ultrasound: Sonography allows us to see whether there are any abnormalities in the tissue and how large the pericardium is. In addition, fluid can be detected and an assessment made as to whether the heart is restricted in its function by this. We can also detect deposits of inflammatory proteins during this examination.
  • Electrocardiogram (ECG): The ECG shows typical changes – such as reduced beats.
  • Imaging procedures: We obtain even more detailed information through imaging procedures. Magnetic resonance imaging (MRI), computer tomography (CT) or positron emission tomography (PET) can provide information about the type and severity of the disease. A CT scan makes it possible to determine the thickness of the fluid in the pericardium and its calcification. In the case of chronic pericarditis, a cardiologist can use this method to determine whether an armored heart, i.e. calcification of the pericardium, is present.

Signs of pericardial tamponade or an armored heart

Recurrent inflammation of chronic pericarditis can lead to scarred adhesions and calcium deposits. As a result, the tissue of the pericardium becomes immobile and the heart’s mobility is impaired. Hence the name “constrictive pericarditis” for this complication.

If too much fluid accumulates in the pericardium, a pericardial tamponade occurs. The heart is compressed due to the pronounced pericardial effusion. As a result, the blood can no longer flow into the ventricles and too little blood enters the circulation. At the same time, the blood builds up in the veins because it can no longer flow into the ventricle. Pericardial tamponade manifests itself with the symptoms of shock, in particular a drop in blood pressure. Other signs are pain in the upper abdomen and congested veins in the neck. Quick action is urgently required in this emergency!

Prevention, early detection, prognosis

If you have a serious infection, you should take it easy as far as possible and, above all, not do any sport. This behavior will prevent pericarditis. It is also important to treat underlying diseases such as metabolic problems, cancer or infections as early as possible. Especially if you have a weak immune system, you should pay attention to warning signs such as chest pain and visit us in good time. Recurrent fever and persistent fatigue can also be signs of pericarditis.

Course and prognosis of pericarditis

The prognosis for pericarditis is good in most cases. Mild courses heal without residue. The chances of recovery are particularly good with early treatment. In many cases, pericarditis heals after one to three weeks. However, an idiopathic form of pericarditis – i.e. a disease with no apparent cause – can take a chronic course. The symptoms then recur for years and can cause serious damage to the heart over time. Complications such as pericardial tamponade or an armored heart are dangerous and lengthy to treat.