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Did you know? The pain of pericarditis actually changes with changes in body position!
Pericarditis is an inflammation of the fibrous sac surrounding the heart (pericardium). Its symptoms often include sudden, sharp chest pain that may extend into the shoulders, neck, or back. According to research, this pain is usually less severe when sitting up or leaning forward, but can increase significantly when lying down or taking deep breaths.
The location and change of pain is an important feature of pericarditis, which makes it diagnostically different from a heart attack.
Other symptoms of pericarditis include fever, weakness, heart palpitations, and shortness of breath. Although the onset of symptoms is usually sudden, some patients experience a gradual worsening. The cause of pericarditis is often unknown, but it is thought to be mostly caused by a viral infection. Other possible causes include bacterial infections (such as tuberculosis), heart attack, cancer, autoimmune diseases, and chest trauma.
Diagnosis process
For the diagnosis of pericarditis, doctors usually base their judgment on the characteristics of chest pain, pericardial friction during auscultation, specific electrocardiogram changes, and fluid around the heart. A heart attack can cause symptoms similar to those of pericarditis, but certain differences between the two often make the diagnosis clear.
The classic manifestation of pericarditis is a pericardial friction rub audible on auscultation, which is usually located beneath the left heart near the sternum.
Diversity of symptoms
The main symptom of pericarditis is chest pain, which usually starts from the lower heart or left side of the chest and radiates upward to the end of the shoulder blade. The pain is relieved when sitting or bending over, but worsens when lying down or breathing in. In addition to chest pain, other possible symptoms include a dry cough, fever, fatigue, and anxiety.
Because the symptoms of pericarditis are similar to those of a heart attack, some patients may be incorrectly diagnosed as having a heart attack.
Risk of complications
Pericarditis may progress to pericardial effusion and eventually cardiac tamponade. This usually follows the presentation of classic symptoms of pericarditis, and the patient then displays signs of cardiac tamponade, including lethargy, hypotension, distant heart sounds, and jugular venous distension. In some cases, an electrocardiogram or Holter monitor will show electrical alternans, which represent the heart shaking in the fluid-filled pericardium. Diagnosing cardiac tamponade usually requires transthoracic ultrasound.
Diverse causes
Pericarditis can have a variety of causes, including infection: viral, bacterial or fungal. Tuberculosis is a common cause in some countries, especially developing countries, while in developed countries about 85% of pericarditis cases are thought to be viral. Common viruses include coxsackievirus, herpes simplex virus, and measles virus.
In addition to infection, autoimmune diseases, heart attacks, and a variety of other factors can cause pericarditis.
Treatment options
For viral or unexplained pericarditis, treatment is usually based on nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, which may be combined with colchicine to reduce the risk of recurrence. In some serious cases, antibiotics, steroids, or pericardiocentesis may be necessary. In cases that do not provide relief with anti-inflammatory drugs, immunosuppressants and other new treatments may be considered.
Surgical removal of the pericardium (pericardiectomy) may also be considered in severe cases, which improves heart function but comes with certain risks.
Epidemiology
Pericarditis is a relatively rare disease, and according to statistics, about 3 people per 10,000 people are affected every year. The most commonly affected people are men between the ages of 20 and 50, and about 30% of cases experience multiple attacks.
Regardless of the cause, the pain associated with pericarditis changes with positioning undoubtedly presents unique diagnostic and treatment challenges for this disease. In this situation, how can we better help patients manage this pain?
