Viral and Acute Pericarditis - Causes, Types, Symptoms, Diagnosis, and Treatment

What Is Meant by Acute Pericarditis?

Acute pericarditis is a painful inflammation of the pericardium, the fluid-filled sac that surrounds the heart. The pain typically intensifies when lying down or during inhalation. Depending on its cause, acute pericarditis is usually treatable, and most individuals with this condition recover with minimal or no complications.

What Impact Does This Condition Have on the Body?

Normally, the pericardium provides enough space for the heart to expand and fill with blood between beats. While pericardial inflammation alone is typically not dangerous, it can lead to serious complications. This occurs when fluid accumulates within the pericardium, known as a pericardial effusion, and compresses the heart. Swelling and fluid accumulation in the pericardium can occupy the space around the heart, causing crowding. If this fluid buildup occurs gradually, the pericardium may stretch to accommodate the extra fluid, allowing the heart to function properly. However, if it happens rapidly, the fluid exerts pressure on the heart, preventing it from expanding and filling with blood as it should. This decreases the heart's ability to pump blood and leads to a condition called cardiac tamponade, a life-threatening emergency. Cardiac tamponade can cause the heart to stop, which can be fatal within minutes.

What Are the Causes of Acute Pericarditis?

Below are some causes of acute pericarditis:

• Viral infections - Like Coxsackie B virus, HIV (human immunodeficiency virus), influenza, and SARS-CoV-2 (severe acquired respiratory syndrome Coronavirus 2).

• Bacterial infections - Like Lyme disease, staphylococci, streptococci, and tuberculosis.

• Fungal infections - Such as candidiasis and histoplasmosis.

• Certain drugs - Like Penicillin, Phenytoin, and anticoagulants.

• Autoimmune diseases - Systemic lupus and systemic sclerosis.

• Myocardial infarctions and post-myocardial infarction syndrome.

• Inflammatory disorders - Like amyloidosis.

• Trauma.

• Cancer.

• Radiation therapy.

What Are the Signs and Symptoms?

In almost 90 percent of cases, patients present sharp chest pain radiating to the neck, jaw, and arms, imitating a myocardial infarction (heart attack). The pain lasts for hours and may last for days if not approached promptly with treatment. It diminishes by sitting up or bending downward and intensifies when lying supine and taking a deep breath. Other symptoms may be generalized fatigue, fever, and cough.

What Is the Difference Between Acute Pericarditis and Infarction?

The only difference that can help separate these two from each other is that the pain changes with body positions in pericarditis. In contrast, the pain is usually constant with continuous pressure in infarction.

What Are the Types of Pericarditis?

Yes, there are a few types of pericarditis based on the duration of the symptoms.

1. Acute Pericarditis: Here, the symptoms last less than three months. They may resolve within a week or two. This type develops quickly and often causes a pericardial effusion, the accumulation of fluid in the pericardium that could be blood and serious. They often develop into a subacute or chronic condition. The inflammation can extend to the epicardial myocardium (the outermost layer of the heart). There could be hemodynamic effects, but they are sporadic to be seen. Acute pericarditis can emerge secondary to myocardial infarction.

2. Subacute Pericarditis: Here, the symptoms occur within weeks to months of inciting.

3. Chronic Pericarditis: Here, the symptoms typically persist for more than six months.

4. Recurrent Pericarditis: Here, there are repeated episodes of acute pericarditis.

5. Constrictive Pericarditis: The thin sac surrounding the heart becomes thickened and scarred in this condition. According to studies, 46 percent of patients undergo surgical therapy of their previous heart constrictions.

What Tests Can Confirm Acute Pericarditis?

1. Blood tests to check the signs of heart attack and infection.

• Complete blood count and basic metabolic panel.

• Erythrocyte sedimentation rate (ESR).

• Cardiac enzyme levels.

2. Electrocardiography.

3. Chest X-ray.

4. Echocardiography.

5. Doppler studies.

What Is the Treatment of Acute Pericarditis?

Hospitalization is for patients with an initial episode of acute pericarditis. Many patients with high-risk conditions like immunosuppression, oral anticoagulant therapy, or failed to respond to NSAIDs (nonsteroidal anti-inflammatory drugs) are hospitalized while others are treated in outpatient departments.

The main aim of treatment is to focus on treating the underlying cause, avoiding complications, and reducing pain and inflammation.

Acute pericarditis is generally treated with,

• Non-steroidal anti-inflammatory drugs reduce the inflammation of the pericardium. They also relieve lingering pain in patients. No evidence shows that NSAIDs are superior to others for treating pericarditis. However, Aspirin and Ibuprofen are the most common drugs advised.

• Colchicine may be a helpful alternative in patients who cannot take NSAIDs and corticosteroids or have significant side effects. These agents are usually advised to treat recurrent pericarditis, showing a significantly lower recurrence rate. It is also combined with NSAIDs to decrease the rate of recurrence. It is contraindicated in patients with renal impairments.

• Glucocorticoids are not the first-line therapy in patients with acute pericarditis. Patients who do not respond to an NSAID may necessitate a short course of a corticosteroid. They increase the likelihood of recurrent pericarditis. Hence, they are used only in certain complications when the patient has a connective tissue disease and uremia. The most common drug advised is Prednisone.

• Antibiotics are advised when the underlying cause is a bacterial infection.

• Antifungals are advised when the underlying cause is a fungal infection.

Complicated cases may need a pericardiocentesis (removing a small fluid volume around the pericardium), which treats the effusion and corrects the hypotension.

How Can Individuals Care for Themselves and Manage Their Symptoms?

Because acute pericarditis shares similar symptoms with a heart attack, it is crucial not to self-diagnose or attempt to manage the condition without consulting a healthcare provider. Given that a heart attack is a life-threatening emergency, any chest pain should be treated as such. Delaying treatment for a heart attack can result in permanent heart damage, so it's essential to seek

How Quickly Will Individuals Feel Better After Starting Treatment?

The time it takes to feel better after developing acute pericarditis depends on the severity of the condition, its underlying cause, and the treatments used. Generally, most people begin to feel better within one to three weeks of treatment, but full recovery may take several months.

Conclusion:

The outcome is good when it is treated the right way at the right time. Most of the patients recover in a few weeks to three months. However, it can come back if the episodes continue. Acute pericarditis cannot be prevented, but chronic pericarditis can. Identifying the signs and symptoms at the earliest without delay, and getting it treated becomes salient to avoid the gradual increase in complications.