Pericarditis is an inflammation of the pericardium (outer lining of the heart or heart sac).
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Pericarditis is often accompanied by myocarditis – inflammation of the heart muscle. Pericarditis and myocarditis often occur simultaneously and are caused by the same factors.
Cause of the disease
The most common cause of inflammation of the pericardium and myocardium are cardiotropic viruses. The disease can also be caused by connective tissue disease, inflammatory bowel disease, the effects of radiation therapy or drug use.
1. Infections that cause pericarditis:
Viruses: Coxsackie A and B, Echoviruses, Epstein-Barr virus (EBV), CMV – cytomegalovirus, human herpes virus 6 (HHV6), adenovirus, influenza virus type A and B virus, Lyme B19, hepatitis B and C, human immunodeficiency virus (HIV), the virus chickenpox (Varicella), mumps virus (mumps), measles, rubella, polio, rhinovirus, vaccinia virus.
2. The most common bacteria that cause pericarditis: tuberculosis (4-5%), Coxiella Burnetii.
3. Other bacterial infections (more rare): pneumococcal, meningococcal, gonococcal, staphylococcal, Haemophilus influenzae, Chlamydia, Leptospirosis, Listeria.
4. Fungal infections are rarely the cause of pericarditis. In patients with a weakened immune system (immunosuppression) agents may be aspergillosis, blastomycosis, candidiasis.
5. It is very rare pathogens can be echinococcus and taxoplasma.
6. Infectious causes meningitis, autoimmune heart, condition after injury syndromes myocardial membrane (after myocardial/pericardial injury syndrome), after acute myocardial infarction syndrome, pericardial condition after surgery.
7. Pericarditis after catheterization, pacemaker, ablation.
8. The inflammation of the blood vessels (vasculitis), and connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis (rheumatoid arthritis), systemic scleroderma (systemic sclerosis), sarcoidosis, Churg-Strauss disease, acute rheumatic fever, Sjogren’s syndrome, Behcet disease, Familial Mediterranean fever (FMF), inflammatory bowel disease: Crohn’s disease, ulcerative colitis.
9. Pericarditis of malignant tumors. Primary tumor (rare): pericardial mesothelioma. Metastatic breast cancer, lung cancer, lymphoma.
10. Metabolic causes: uremia, myxedema
11. Pericarditis after radiation therapy
12. After drug therapy (rare): procainamide, hydralazine, phenytoin (eg, the syndrome of systemic lupus erythematosus), isoniazid, penicillin (pericarditis hypersensitivity with eosinophilia), doxorubicin, daunorubicin, methyldopa, methysergide, sulfonamides, cytarabine, phenylbutazone, cocaine.
Clinical manifestations of the disease
The disease manifests itself as a typical viral infection with fever, systemic effects, muscle aches, sore throat, diarrhea, vomiting. Further development is pleuritic chest pain, difficulty breathing, weakness, lack of stamina, heart palpitations.
Different viruses tend to defeat several areas that could determine the course of the disease.
Patients with B19 virus infection (parvovirus B19), as a rule, ask help earlier than other patients because of severe pain in the chest. Cardiac function in these patients is only slightly reduced or maintained.
While infecting human herpes virus 6 (HHV6) clinical picture looks as heart failure and reduced heart function.
Diagnosis of pericarditis
In most cases involving pericarditis pericardium and myocardium. According to the recommendation of an experienced specialist can be conducted the following studies:
Echocardiography. Necessary to assess the condition of the heart muscle.
Medical examination specialist.
Electrocardiography (ECG).
Laboratory tests. Contents cardiac enzymes, such as creatine or troponin, can be increased, depending on the degree of damage to the heart muscle.
Inflammatory markers – ESR and C-reactive protein (CRP). Usually rise in inflammatory diseases of the pericardium and myocardium, but there are rare cases of pericarditis with normal CRP.
A blood test nuclear components antibodies (ANA). Performed for suspected systemic disease.
Blood cultures. Can help in cases of purulent pericarditis.
Magnetic resonance imaging of the heart. (MRI) helps to identify changes in cardiac tissue, typical of pericarditis and myocarditis.
The test is performed with injection of contrast material gadolinium. The contrast agent passes through the blood vessels. Due to the contrast agent, the expert can detect the injury of the heart muscle.
Coronary angiography. Some patients are less prone to pain is necessary to exclude coronary artery disease. To do this, performed computed tomography (CT) or coronary angiography.
CT chest. Performed for suspected tuberculosis, cancer, or systemic diseases.
Mammography. Helps to eliminate the presence of liquid membrane of the heart, in the light of malignancy.
Biopsies were frequently used to diagnose myocarditis, but now hardly used for several reasons: firstly, biopsy is an invasive procedure, accompanied by complications. Secondly, a biopsy is usually taken from the muscle of the right ventricle, and myocardial infarction can be in various areas. In addition, MRI and isotope scanning of the heart, to evaluate the state of the heart is not invasive.
Treatment for pericarditis
Patients with suspected pericarditis or myocardial recommended to be hospitalized for evaluation, research and monitoring.
Initial treatment may be a non-steroidal anti-inflammatory drugs (NSAIDs), a long course of treatment to full normalization of CRP. Such drugs may be acetylsalicylic acid (aspirin), indomethacin, ibuprofen. Medications must be assigned by an experienced physician. Reduced doses of aspirin and other NSAIDs should be gradual. During treatment requires regular assessment of the level of C-reactive protein in the blood.
Colchicine is recommended for the treatment of recurrent pericarditis bursts (recurrent pericarditis) and may be effective in acute inflammation of the heart membrane (acute pericarditis), and acute heart meningitis.
Patients with renal insufficiency colchicine is not recommended.
Prednisone may be appointed in cases of intolerance to other means of treatment failure or contraindications of NSAIDs.
Monitoring
Need to limit physical activity for 6 weeks and be re-echocardiography at 1, 6 and 12 months, especially in patients with impaired cardiac function and heart failure receiving inhibitors of the enzyme conversion (ACE inhibitors) and beta-blockers.
