Pericarditis: Pathophysiology, Types, Signs and Symptoms, Complications (Pericardial Effusion, Cardiac Tamponade and Constrictive Pericarditis), Causes, …
Pericarditis refers to 
inflammation of the pericardium,  
the double-walled, fluid-filled sac 
that encloses the heart. The pericardial  
cavity contains a fluid which serves as 
lubricant and allows the heart to contract  
and relax with minimum friction. It also protects 
the heart from infection and over-distension. 
The most common form is acute pericarditis, 
meaning symptoms develop suddenly  
but do not last long. Subacute and chronic 
forms develop more slowly and last longer.  
Recurrent pericarditis is when there are 
symptom-free intervals in between episodes. 
A typical symptom of acute pericarditis is 
chest pain, which can be sharp or dull. The  
pain may radiate to the left shoulder or arm, 
similar to that of a heart attack, or ischemia.  
Unlike ischemic pain, however, pericardial 
pain is worsened with deep breathing,  
coughing, swallowing, or lying flat; and 
improved with sitting up or leaning forward. 
Inflammation of the pericardium can cause 
fluid to accumulate in the pericardial cavity.  
This is called pericardial effusion. The 
increased fluid volume may limit cardiac filling,  
leading to low cardiac output and sometimes 
life-threatening circulatory shock,  
known as cardiac tamponade. The rate at which 
fluid accumulates is often more critical  
than the volume of fluid. Slow accumulation 
of a large volume may not cause tamponade,  
but a relatively small effusion can do so if it 
builds up too rapidly, because the pericardium  
cannot stretch quickly enough to accommodate it.
Less commonly, chronic inflammation may also  
result in a thickened and stiffened pericardium, 
a condition known as constrictive pericarditis.  
As the stiff pericardium reduces cardiac filling, 
blood backs up in the body’s veins and the lungs,  
where it came from. A peripheral venous congestion 
leads to swelling of legs and abdominal organs,  
while an elevated pulmonary pressure 
results in difficulty breathing. 
The cause of pericarditis is often difficult 
to determine. Possible causes include:  
viral infection, bacterial infection, injury to 
the chest, inflammatory disorders, other health  
problems, and some medications. Pericarditis 
may also develop following a heart attack  
or cardiac surgery. It can happen immediately 
after, or as a delayed form several weeks later. 
Diagnosis can usually be made 
based on evaluation of chest pain,  
and presence of pericardial rub, a characteristic 
sound produced when pericardial layers rub against  
each other; but tests are commonly performed 
to confirm, and to exclude heart attack.  
In about half of patients, electrocardiograms show 
changes that go through a characteristic sequence  
of four stages. Pericardial effusion, if present, 
can be seen with echocardiography or chest x-ray. 
Treatment depends on the cause  
and disease severity. Mild cases may get 
better on their own without treatment. 
Pain and inflammation can be 
relieved with anti-inflammatories. 
Corticosteroids may be used for non-infectious 
cases that do not respond to other medicines.  
Bacterial infections are treated with 
antibiotics, and possibly drainage. 
If cardiac tamponade is present, a 
procedure called pericardiocentesis  
is performed to remove the excess fluid from 
the pericardial cavity. Severe constrictive  
pericarditis may require surgical removal 
of the pericardium, as a last resort.

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