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Pericarditis

Definition


Disease: Pericarditis Pericarditis
Category: Cardiovascular diseases
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Disease Definition:

Pericarditis happens when the thin sac-like membrane surrounding the heart (the pericardium), becomes swollen and irritated. Pericarditis is often an unexpected and short-lived (acute) condition, that usually results in chest pain and occasionally other symptoms. The condition will be considered chronic if the symptoms develop more gradually or persist. The rubbing of two inflamed or irritated layers of the pericardium against one another causes a sharp chest pain related to pericarditis.
While mild pericarditis might get better on its own, more severe cases might need to be treated with medications and in some rare cases, with surgery. Early diagnosis and treatment could help decrease the risk of long-term complications.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

While chronic pericarditis lasts for six months or more, acute pericarditis often lasts less than a few weeks. The most common symptom of acute pericarditis is sharp, stabbing chest pain either behind the breastbone or in the left side of the chest However, some people with this condition describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.
Sitting up and leaning forward could usually relieve the pain. The pain usually becomes intense when the patients lies down or inhales deeply and may travel into the left shoulder and neck. Swallowing food, taking a deep breath and coughing might also make the pain worse. Sometimes, it might be hard to differentiate between the pain that occurs with a heart attack and the pericardial pain.
Chronic pericarditis is often painless. It is usually associated with an accumulation of extra fluid around the heart (pericardial effusion).
Shortness of breath is the most common symptom of chronic pericarditis.
Signs and symptoms of pericarditis, depending on the type, might include either some or all of the following:
-    Low-grade fever
-    Dry cough
-    Sharp, piercing chest pain over the center or left side of the chest
-    Abdominal or leg swelling
-    An overall sense of weakness, fatigue or feeling sick
-    Shortness of breath when reclining

When experiencing chest pain, one should seek emergency medical care. Several symptoms of pericarditis resemble those of other heart and lung conditions. The sooner someone’s evaluated, the sooner they could receive proper diagnosis and treatment. For instance, even though acute chest pain might result from pericarditis, it might also be caused by a heart attack or  pulmonary embolus, which is the presence of a blood clot in the lungs.

Causes:

The two-layered pericardial sac surrounding the heart normally contains a small quantity of lubricating fluid. The sac becomes inflamed and the friction caused by it contributes to chest pain in pericarditis. In some cases, pericardial effusion may result if the amount of fluid in the pericardial sac increases. Usually determining the reason underlying pericarditis is difficult. Mostly, doctors either suspect a viral infection or are unable to determine a cause (idiopathic).
Because of the irritation of the underlying damaged heart muscle, pericarditis could develop after a major heart attack. A delayed form of pericarditis that is called Dressler’s syndrome might additionally occur due to antibody formation weeks after a heart attack or heart surgery. Dressler’s syndrome is considered to be the outcome of a mistaken inflammatory reaction by the body to the heart and pericardium called an autoimmune reaction.
Other causes of pericarditis include:
-    Trauma: Motor vehicle or other accidents might cause injury to the heart or chest.
-    Systemic inflammatory disorders: These include rheumatoid arthritis and lupus.
-    Certain medications: Certain medications could result in pericarditis, even though this is not common.
-    Other health disorders: These might include cancer, AIDS, tuberculosis and kidney failure.

Complications

Complications:

Some of the complications may include:

Constrictive pericarditis:
Certain people suffering from pericarditis can develop permanent thickening, scarring and contracture of the pericardium, specifically those with long-term inflammation and chronic recurrences. Constrictive pericarditis usually contributing to severe abdominal and leg swelling in addition to shortness of breath. It is the condition in which the pericardium loses much of its elasticity and is similar to a rigid case that is tight around the heart preventing the heart from functioning properly.

Cardiac tamponade:
This is a dangerous condition that develops when too much fluid is accumulated in the pericardium. This extra fluid puts pressure on the heart and doesn’t allow it to fill properly so that less blood exits the heart, resulting in a dramatic drop in blood pressure. Cardiac tamponade could be fatal when left untreated.

The risk of long-term complications is usually decreased with early diagnosis and treatment.

Treatments:

Depending on the underlying reason of pericarditis as well as its severity, a treatment could be determined. Mild cases of pericarditis may get better on their own without treatment.

MEDICATIONS AND REST
Until feeling better, the patient may be recommended bed rest. The patient is usually prescribed medications that decrease the inflammation and swelling related to pericarditis, such as:

Nonsteroidal anti-inflammatory drugs (NSAIDs):
Aspirin or other NSAIDs are usually successful in treating the pain that is associated with pericarditis.

Narcotic pain relievers:
Stronger pain medications might be required when the pain is severe, like short-term use of morphine.

Colchicine:
This medication decreases inflammation in the body; it might be prescribed as either an initial treatment for pericarditis or as a treatment for recurrent symptoms. Colchicine could decrease the duration of symptoms and reduces the risk of recurrence. Yet, the medication is not safe for people with some pre-existing health problems, like kidney or liver disease.

Corticosteroids:
A steroid medication like prednisone might be prescribed in case NSAIDs or colchicine weren’t beneficial or in case symptoms of pericarditis recur.
Acute episodes of pericarditis commonly linger from one to three weeks, but future episodes could still occur. Within months of the original pericarditis episode, about one in five people experiences a recurrence.
The treatment for pericarditis includes antibiotics and drainage in case a bacterial infection is the underlying cause of the disease.

HOSPITALIZATION AND PROCEDURES:
When there is a possibility of cardiac tamponade occurrence, Which is a dangerous complication of pericarditis due to fluid accumulation in the pericardium, hospitalization might be required. In the presence of cardiac tamponade, the patient might undergo a treatment method known as pericardiocentesis. Sometimes, in severe recurrent cases of pericarditis, pericardiectomy may be suggested, which is the surgical removal of the pericardium.

Pericardiocentesis:
In this operation, a sterile needle or a small tube (catheter) is used to remove and drain the extra fluid from the pericardial cavity. A local anesthetic is given before this process, which is usually performed with echocardiogram monitoring and ultrasound guidance. This drainage might go on for several days throughout the course of hospitalization.

Pericardiectomy:
When diagnosed with constrictive pericarditis, undergoing a surgical operation called pericardiectomy might be required in order to remove the whole pericardium, which has become rigid and is keeping the heart from working properly.

Prognosis:

Not available

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