Pericarditis Treatment in Delhi, India

1. Acute Pericarditis: This form of pericarditis lasts for a short duration, typically a few days to a few weeks. It is the most common type and is often caused by viral infections or idiopathic factors (unknown causes). Other potential causes include bacterial infections, myocardial infarction (heart attack), trauma, or autoimmune disorders.
2. Subacute Pericarditis: Subacute pericarditis refers to an intermediate stage between acute and chronic pericarditis. It typically lasts from a few weeks to three months and is often caused by viral or bacterial infections, connective tissue disorders, radiation therapy, or medications.
3. Chronic Pericarditis: Chronic pericarditis is a long-lasting condition that persists for more than three months. It can result from recurring acute episodes or be caused by underlying conditions such as autoimmune disorders, tuberculosis, cancer, or kidney failure.

1. Infections: Viral infections, such as the Coxsackie virus, Epstein-Barr virus, or influenza, are the most common cause of pericarditis. Bacterial, fungal, and parasitic infections can also lead to pericardial inflammation.
2. Autoimmune Disorders: Certain autoimmune conditions, including lupus, rheumatoid arthritis, or scleroderma, can cause pericarditis as part of the overall disease process.
3. Post-Cardiac Injury Syndrome: Pericarditis may develop following a heart attack, heart surgery, or other cardiac injuries.
4. Medications: Some medications, such as hydralazine, procainamide, or isoniazid, can induce pericardial inflammation as an adverse reaction.
5. Cancer: In rare cases, pericarditis can be associated with malignancies, particularly lung cancer, breast cancer, or leukaemia.

1. Chest Pain: The hallmark symptom of pericarditis is sharp, stabbing chest pain, often behind or beneath the breastbone. The pain can radiate to the neck, shoulder, or back and typically worsens with deep breaths, coughing, or lying flat.
2. Difficulty Breathing: Pericarditis can cause shortness of breath, especially during exertion or when lying down.
3. Fatigue: Generalised fatigue and weakness may be present due to the underlying inflammation and decreased cardiac function.
4. Fever: In cases of infectious pericarditis, fever may be present.
5. Pericardial Friction Rub: A characteristic scratching or grating sound, known as a pericardial friction rub, can be heard with a stethoscope placed on the chest.

1. Medical History and Physical Examination: The doctor will inquire about the patient's symptoms and perform a physical examination, including listening for a pericardial friction rub.
2. Electrocardiogram (ECG): An ECG can reveal characteristic changes, such as ST-segment elevation or PR segment depression, which may indicate pericarditis.
3. Echocardiogram: This imaging test uses sound waves to produce detailed images of the heart and can help visualise any pericardial effusion (accumulation of fluid) and assess cardiac function.
4. Blood Tests: Blood tests may be conducted to check for markers of inflammation, infection, or autoimmune disorders.
5. Chest X-ray or MRI/CT Scan: These imaging techniques may be used to evaluate the size and shape of the heart and identify any potential causes or complications.

1. Medications:
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or aspirin, are often the first-line treatment to relieve pain and reduce inflammation.
• Colchicine: This medication is commonly used in combination with NSAIDs to reduce the risk of recurrent pericarditis.
• Corticosteroids: In cases of severe or refractory pericarditis, corticosteroids may be prescribed to suppress inflammation.
• Antibiotics or Antivirals: If a bacterial or viral infection is identified, specific antimicrobial agents may be prescribed.
2. Pericardiocentesis: In the presence of a large pericardial effusion or cardiac tamponade (compression of the heart due to fluid accumulation), a procedure called pericardiocentesis may be performed to drain the excess fluid.
3. Pericardial Window: In chronic or recurrent cases, a surgical procedure called a pericardial window may be necessary to remove a portion of the pericardium, allowing fluid to drain continuously.

Prevention measures for pericarditis depend on the underlying cause:

• Practising good hygiene and minimising exposure to individuals with respiratory infections can reduce the risk of viral and bacterial pericarditis.
• Vaccination against viral infections, such as influenza or varicella-zoster, can help prevent related cases of pericarditis.
• Promptly treating infections, especially those affecting the respiratory or cardiovascular systems, may reduce the risk of pericarditis as a complication.

1. Pericardial Effusion: Pericarditis can lead to the accumulation of excess fluid in the pericardial sac, resulting in pericardial effusion. If the effusion becomes large, it can cause cardiac compression (cardiac tamponade) and compromise heart function.
2. Constrictive Pericarditis: Prolonged or recurrent inflammation can lead to the formation of scar tissue, resulting in the pericardium becoming thick and rigid. This condition, known as constrictive pericarditis, impairs the heart's ability to expand and fill properly during each heartbeat.
3. Recurrent Pericarditis: Pericarditis may recur, even after successful treatment, particularly in cases of idiopathic or autoimmune-related pericarditis.

The prognosis for pericarditis is generally good. Most cases are self-limiting, and symptoms resolve with appropriate treatment. However, the prognosis can be influenced by the underlying cause, complications, and response to treatment. Recurrent or chronic cases may require long-term management and monitoring to prevent complications and improve quality of life.

1. Is pericarditis a common condition?

   Pericarditis is relatively common, with an estimated incidence of 1 in 1,000 people per year. Acute pericarditis accounts for the majority of cases.

2. Can pericarditis be life-threatening?

   While most cases of pericarditis resolve without complications, severe cases or those associated with complications like cardiac tamponade or constrictive pericarditis can be life-threatening if not promptly treated.

3. Can pericarditis recur?

   Yes, pericarditis can recur, particularly in cases of idiopathic or autoimmune-related pericarditis. Recurrent pericarditis may require long-term management and monitoring.

4. Can pericarditis be prevented?

   Preventive measures focus on addressing the underlying causes, such as maintaining good hygiene, getting vaccinated, and promptly treating respiratory or cardiovascular infections.

5. Can pericarditis lead to heart failure?

   Pericarditis itself does not typically cause heart failure. However, complications like pericardial effusion or constrictive pericarditis can impair heart function and potentially lead to heart failure if left untreated.

Reviewed by Dr. Samir Kubba, Director - Clinical and Interventional Cardiology, Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker on 07-July-2023.

• Chest Pain: Different Causes and How to Differentiate