Pericarditis — Inflammation of the Heart Sac
Pericarditis is inflammation of the pericardium — the tough fibrous sac that surrounds and protects the heart. It is a common condition causing sharp chest pain that is often worse on inspiration and lying flat, and better when sitting forward. While most cases are self-limiting, pericarditis can recur and in some cases cause serious complications including pericardial effusion (fluid accumulation) and cardiac tamponade.
Causes
- Viral (most common in developed countries) — Commonly caused by enteroviruses, adenovirus, and Coxsackie B virus. Often occurs after a recent respiratory infection.
- Bacterial/tuberculous — Tuberculosis is an important cause in India. TB pericarditis can progress to constrictive pericarditis, where scarring and thickening of the pericardium restrict normal heart filling.
- Post-cardiac injury syndrome — Pericarditis that develops weeks after a heart attack (Dressler syndrome), cardiac surgery, or catheter-based cardiac procedures.
- Autoimmune — Associated with systemic inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis, and sarcoidosis.
- Uraemic — Occurs in advanced kidney failure due to accumulation of urea and other toxins affecting the pericardium.
- Neoplastic — Caused by cancer involving the pericardium, most commonly from lung cancer or breast cancer metastasis.
Symptoms
- Sharp, stabbing chest pain — The hallmark symptom of pericarditis. Typically worsens with deep inspiration, lying flat, or body movement, and improves when sitting forward and leaning toward the knees (the classic pericardial position).
- Fever — Usually low-grade and caused by the underlying inflammatory process.
- Breathlessness — More likely when a significant pericardial effusion develops and restricts normal heart function.
- Pericardial rub on auscultation — A characteristic scratching or leathery sound heard with a stethoscope due to inflamed pericardial layers rubbing together.
Cardiac tamponade — a medical emergency
When a large pericardial effusion compresses the heart, preventing adequate filling — causing severe breathlessness, low blood pressure, distended neck veins, and muffled heart sounds (Beck's triad). Requires immediate pericardiocentesis. Call +91-9000352998 immediately if these symptoms develop.
Diagnosis
- ECG — Shows characteristic diffuse saddle-shaped ST-segment elevation with PR-segment depression, helping distinguish pericarditis from a heart attack pattern.
- Echocardiogram — Identifies pericardial effusion, assesses its size, and detects signs of cardiac tamponade physiology.
- Blood tests — CRP and ESR are typically elevated due to inflammation. Troponin may be raised if myocarditis is also present (myopericarditis). Additional tests may include blood cultures and tuberculosis evaluation.
- Cardiac MRI — Detects pericardial enhancement confirming active inflammation and is especially useful in recurrent, persistent, or complex cases.