Pericarditis (Acute and Chronic) Symptoms, Pain and Causes

Most cases of pericarditis are acute in nature eliciting sudden and intense symptoms that requires prompt treatment as it may quickly complicate to restrict the normal pumping action. This may occur with excess fluid accumulation around the heart (pericardial effusion) leading to a condition known as cardiac tamponade or in the chronic setting, fibrous tissue develops around the heart which is known as constrictive pericarditis.

Recurrent episodes of acute pericarditis may lead to the structural changes and complications seen in chronic pericarditis. With certain causes of pericarditis, particularly those that contribute to granulomatous pericarditis like TB, fungal infections, sarcoidosis and rheumatic fever, the symptoms may develop gradually and remain mild for a prolonged period of time. Chronic pericarditis is often painless which further contributes to a delay in diagnosis.

Signs and Symptoms of Pericarditis

Pericarditis Pain

The characteristic pain in pericarditis is sharp or stabbing chest pain behind the sternum (retrosternal / breastbone pain). It may be felt in the middle of the chest (central chest pain) or slightly to the left (left side chest pain). The pain usually worsens during movement, deep breathing, swallowing, coughing, changing position and exercise. Patients often report a relief of pain when leaning forward.

Pericardial Friction Rub

This is a sound that is heard upon auscultation (listening to the heart sounds with a stethoscope). It is described as a rough or grating sound (crunching or rubbing) that is most prominent during systole, end of expiration and when the patient is leaning forward.

Other Symptoms of Pericarditis

Most of the other symptoms of pericarditis are non-specific for the condition and often not as prominent as the pain and pericardial friction rub. These other symptoms includes :

  • Low grade fever, seen especially with infections and autoimmune conditions
  • Dry cough which exacerbates the chest pain
  • Shortness of breath, especially when lying down
  • Rapid breathing and rapid heart rate may also be noted

In more severe cases, swelling of the legs and/or abdomen, malaise and weakness may also be seen with pericarditis.

Causes of Pericarditis

The causes of pericarditis can be broadly divided into infectious and non-infectious. Infectious pericarditis, particularly bacterial, can progress rapidly and lead to severe complications in a short period of time. Viral pericarditis may be just as acute but depending on the virus involved, it can resolve spontaneously with minimal treatment. Other infectious causes includes tuberculosis, fungal infections and certain parasites which tends to lead to a more chronic pericarditis.

Among the non-infectious causes, the immune mediated conditions feature prominently. This includes rheumatic fever, systemic lupus erythematosus (SLE) and scleroderma. There is often an immune component involved in other conditions like after a myocardial infarction (heart attack) known as Dressler syndrome, cardiothoracic surgery and hypersenstivity to drugs.

Other causes may include heart diseases and trauma, including a myocardial infarction with secondary inflammation of the pericardium, injury to the pericardium, blunt chest injury, surgery, exposure to radiation, uremia and mediastinal tumors.

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