Whenever there is an accumulation of the pericardial fluid which is having enough pressure affecting cardiac function, then this is called as cardiac tamponade. Usually pericardial effusion is caused due to disturbance in the equilibrium between the production and re-absorption of fluid present in pericardium, or due to presence of any structural abnormality allowing the fluid to enter into the pericardial cavity. The pericardial fluid levels normally from fifteen to fifty milliliters.

It may be of transudative type such as congestive cardiac failure, myxedema, and nephrotic syndrome, or of exudative type such as tuberculosis, spreading from empyema or of hemorrhagic type like trauma, or rupture of aneuryms, and malignant effusion.

Causes of pericardial effusion

The causes of the pericardial effusion are pericarditis, or other infections, may be viral infection where the virus named coxsackie is causative, many times pericardial effusion is followed after the inflammatory disorders like lupus and post-myocardial infarction pericarditis which is commonly known as Dressler’s syndrome. Cancer may be also one factor which has spread to the pericardium. Other causes are cardiac surgery, Trichinosis and renal failure with hematuria.

Symptoms of pericardial effusion

A small type of pericardial may not have any symptoms rather than the chest pain and other pressure symptoms. Many times pericardial effusion is also seen after the repair of specific type of cardiac defect like an atrial septal defect secundum, or ASD.  When these are repaired then there is more chance of development of a pericardial effusion, this happens due to one of the procedure of repairing. One type of repairing procedure is of ASD in which a piece of the peridcardial tissue is taken and is used for attaching as a patch for the hole in the atrial cavity.

The radiographic sign of pericardial effusion is called as water-bottle heart, in this sign, there is enlargement of the cardio pericardial silhouette and it assumes like the shape of a flask or of water bottle. So it is called as water-bottle heart. It is also seen associated along with Ewart’s sign.

Treatment of pericardial effusion

Treatment of pericardial effusion depends on its underlying cause and how severely the heart is impaired. Usually pericardial effusion caused due to a viral infection reveals within a few weeks that too without any treatment. And many of the pericardial effusions remains small and they never need treatment. But if the cause of pericardial effusion is a condition such as lupus then treatment is needed here containing anti-inflammatory drugs.

If the effusion is disturbing the function of the heart and is causing the cardiac tamponade then it needs the draining of fluid by inserting the needle through the chest wall into the pericardial space. Sometimes a drainage tube is left there itself for several days. Surgical drainage may be often required by pericardiocentesis, in this procedure, a needle or a catheter is used to drain excess fluid.

Commonly constructive pericarditis is caused due to another condition which is responsible for development of inflammation around the heart, such as cardiac surgery, Tuberculosis and Radiation therapy to the chest.

The conditions that less commonly causes the constructive pericarditis are:

Accumulation of abnormal amount of fluid within the lining of the heart may be due to the pericarditis caused because of bacterial infection or surgical complications. Mesothelioma is also considered as a cause for it. Many times it is also found that there is no any apparent cause for the development of the constrictive pericarditis.

The inflammation makes the lining of the heart more thickened and very rigid that produces difficulty for the heart to expand enough whenever it beats. And due to this, the chambers of the heart do not fill properly with enough amount blood. Thus it causes the swelling of the heart and also the other symptoms of heart failure.

Common features of constrictive pericarditis

There are various symptoms of chronic constrictive pericarditis. Patient may feel dyspnea i.e. difficulty in breathing, this symptom develops slowly and then gets worse. Many times patient feel fatigue and excessive tiredness, edema i.e. swelling on legs and on ankle joint for long time, even the abdomen is seen swollen. Weakness is also quite common.

Diagnosing and treating constrictive pericarditis

It is very difficult to make out the diagnosis of Constrictive pericarditis. It may be misdiagnosed with restrictive cardiomyopathy and cardiac tamponade because of the similar signs and symptoms. The physician may need to look for these conditions while making a diagnosis. After the physical check-up of the patient, it may show that veins of the neck stick out; this suggests raised blood pressure in that area. This condition is called as Kussmaul’s sign. While listening to the chest with the help of stethoscope, the physician notices the weak or distant type of heart sounds. While going through physical exam it may also find that there is swelling of the liver and accumulation of fluid in the abdominal region.

Along with the physical exam some more tests are to be done, those are MRI-chest, CT scan chest, ECG, X-ray chest and either cardiac catheterization or coronary angiography.

To improve the cardiac function is the main aim of the treatment. First the cause must be identified and then must be treated. For this, treatment may need certain antibiotics, drugs those are tuberculosis or other types of treatments. Such as, diuretics are used in small doses in order to remove the excess fluid from the body.

To get rid of the pain analgesics are prescribed. Some of the patients must be told to decrease their activity. Even low-sodium diet recommended. The exact treatment is a surgery called pericardiectomy. In this surgery there is removing or cutting the scarring and the affected part of the pericardium.

In case of acute pericarditis, commonest symptom is sharp and stabbing chest pain that is felt just underneath the breastbone or slightly left side of the chest. Nevertheless, some of the people suffering from acute pericarditis report their chest pains as dull and achy or feeling like someone has put lots of pressure on their chests. The intensity varies and they describe that the pain may travel to their neck, left shoulder and then coming down to the left arm finally ending in left palm (called as radiating pain in medical science).

The chest pain is most discomfort among all the symptoms pericarditis features. The heart becomes heavy and there is a feeling of something that is crushing the heart. The pain generally steps up when the patient lies down or takes deep breath. Oppositely, it eases up when the patient sits up and leans forward. At times, it becomes difficult to differentiate between the pericardial chest pain and the pain that occurs during heart attack.

Apart from chest pain, there is some other symptoms pericarditis as mentioned below:-

§  Mild fever or feverish

§  Shortness of breath (medically known as dyspnea)

§  Coughing (generally with phlegm)

§  Hiccups (medically known as eructation)

§  Muscle-ache or severe body pain especially left part of the body.

§  Uneasiness

§  Congestion in the thorax/chest region

§  Giddiness (in some cases)

In some of the cases, people suffer from nausea, profuse sweating/perspiration that are associated with chest pain. There might be indigestion that ends up with constipation but not necessary in all the cases of pericarditis. Whatever the symptoms pericarditis has, it makes patient tired, very weak and exhausted. The condition certainly interrupts routine activities and level of consciousness.

The type of chest pain felt during the pericarditis is also different from the angina. The angina generally turns worse with exertion but remains unaffected with deep breathing. In case, the pericarditis is left untreated, it can develop its complications.  The complication is fatal and the patient is at risk of sudden cardiac failure.

The symptoms of complication of pericarditis include severe breathlessness or shortness of breath (dyspnea) and irregular or rapid heartbeats all of a sudden. The coughing is severe and unbearable up to an extent that it becomes difficult for the patient to speak and to breathe. The cough might bring up foamy pink or yellow mucus. The sudden heart failure requires immediate medical attention that requires intensive cardiac care unit admission and proper treatment.

In case of pericarditis caused due to bacterial infection or tuberculosis then various antibiotics are to be used for the pericarditis treatment, whereas different steroids and non-steroidal anti-inflammatory drugs commonly known as NSAIDs such as indomethacin is to be used in other type of cases. Steroids are also to be taken in order to decrease the inflammation in pericarditis which is followed by heart attack. Different types of diuretics are to be taken and low sodium diet is also recommended in the condition of pericarditis.

Though the pericarditis caused due to viral infection gets resolved by itself but sometimes people having pericarditis are to be admitted to the hospital for the observation, especially if there is any chance of getting the condition more serious depending on the symptoms or if there is presence of any type of evidence of a accumulation of the fluid in the pericardial sac in large amount. Sometimes viruses that are responsible for the causation of pericarditis can make attack on the cardiac muscle and so, there is also the development of the heart-rhythm abnormalities or the heart failure.

In most of the people who have developed the pericarditis due to viral infection or idiopathic pericarditis, for them the disease may be a temporary type of botheration which is then forgotten after it gets resolved. However in about one-fourth of people suffering from this type of pericarditis may develop the subsequent episodes of pericarditis, which can reoccur at the intervals of weeks or of months. Usually in such people, anti-inflammatory drugs can be used in order to control the symptoms.

Even these types of cases are seen where there is excessive development of the pericardial fluid that does not allow the hearts to beat properly. In these types of cases, there must be the removal of the fluid as a pericarditis treatment by a cardiothoracic surgeon or an experienced cardiologist.

In rare cases, the development of chronic scarring of the pericardium is also seen, which can be proved as a grievous for keeping the heart from the normal expanding in between heart beats. Thus the heart is unable to fill enough, the ability of the heart of blood supply to the body decreases slowly as the pitting gets more worsen. This type of case is called as constrictive pericarditis and sometime it needs surgery to clean the pericardium and hence to obtain pericarditis treatment.

If you are taking some blood thinners then it is important to discuss it with your physician, so that they are able to prescribe you proper treatment. 

The case of acute pericarditis is common than the case of chronic pericarditis, and it can come in front as a complicated type of infections or a heart attack. The commonest sign of pericarditis is chest pain which radiates towards the back and is ameliorated by sitting in up-forward position and is aggravated in the lying down position. There are many other signs of pericarditis such as; anxiety, fever, fatigue and dry cough. Many times pericarditis is misdiagnosed by the physician as the myocardial infarction, in common words it is known as heart attack.

There are various causes of pericarditis. Oftentimes the cause is unknown. Following are the causes of the pericarditis:

• Idiopathic: The cause behind the illness is not known.
• Viral infection: Many times it is developed followed by a minor viral type of illness mostly by the Coxsackie virus.
• Bacterial infection: Commonly caused by Tuberculosis bacillus. Pericarditis where the tuberculosis is the causative factor, then this condition is quite difficult to diagnose. However, to confirm it, the culturing Mycobacterium tuberculosis from aspirated fluid from the pericardium or pericardial biopsy is required. One system called as ‘Tygerberg scoring system’ is helpful for the physicians to find out whether the cause of pericarditis is tuberculosis or any other.
• Fungal infection.
• Different types of immunologic conditions such as Lupus erythematosus, this is commonly found in females.
• Dressler’s syndrome that is followed by the Myocardial Infarction.
• Any type of trauma to the heart, maybe like any inflammation or infection followed by puncture.
• Uremia: The urea i.e. the nitrogenous waste products that are normally excreted in the urine get accumulated in the blood.
• Some Malignancy
• As a side effect of some drugs such as cyclosporine, isoniazid and hydralazine.
• Maybe the result of the induced Radiation.
• Aortic dissection may be also one of the causes.
• Tetracyclines are also found to be a causative factor for pericarditis.

Most of the cases of acute type of idiopathic pericarditis get resolved without any type of complications. Complications may be like pericardial effusion, constrictive pericarditis and cardiac tamponade.

Fibrinous pericarditis is one of the exudative types of inflammation. Here the pericardium is penetrated by the fibrinous exudate. This is containing the chains of fibrin as well as the leukocytes.

The treatment in the viral pericarditis or the idiopathic pericarditis is obtained with non-steroidal anti-inflammatory drugs, but many other severe types of cases may need the treatments like antibiotics, pericardiocentesis, colchicine, steroids and oftentimes a surgery is preferred as effective way to cure the disease. 

What Causes It?

Acute pericarditis and pericardial effusion have a large number of likely determinants, encompassing viruses, pathogens, fungi, cancerous infection, trauma to the heart (such as barrel injury), pharmaceutical reactions, and emission exposure. In numerous situations, although, the genuine origin is unknown. Constrictive pericarditis generally outcomes from recurring (chronic) pericarditis.

What to Expect at Your Provider’s Office

Your wellbeing care provider will hear to your heart and lungs, take your pulse, and likely tap your barrel and back. They will likely alignment some checks, which may encompass body-fluid work, an electrocardiogram (ECG), an echocardiogram, barrel x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Treatment Options

Pericarditis is generally treated with aspirin or nonsteroidal anti-inflammatory pharmaceuticals (NSAIDs, for example ibuprofen), but the medical practitioner may prescribe corticosteroid medicines. If a bacterial contamination is present, you will be granted antibiotics. If you evolve cardiac tamponade, your medical practitioner may suggest a method called pericardiocentesis, which engages draining fluid from your chest.

Shortening of breath corresponds in fact to a fast and superficial breathing. It is the consequence of the pain upon inspiration or the abundance of the effusion. It is also improved by the leaned forward seated position.

Other symptoms can also occur as hiccup, vomiting, huskiness of the voice, or a dry cough.

Fever is constant and can precede the other symptoms.

2 - Atypical symptoms

The real frequency of pericarditises is probably underestimated: many shapes of pericarditises do not come with symptoms and are spontaneously regressive.

3 - By a complication

Sometimes, pericarditis is responsible for a very voluminous effusion around the heart, which prevents its normal contraction.
This mechanism is responsible for the occurrence of a very important shortening of breath and the BP decrease. Physicians call this illness a cardiac tamponade; it constitutes a grave medical diagnosis.

Pericarditis happens in up to 15% of patients who have acute myocardial infarctions (heart attacks). There is furthermore a late pattern of post-heart-attack pericarditis, called Dressler’s syndrome, that happens weeks to months after the heart attack. Chronic pericarditis happens when the pericardial inflammation does not determination inside a couple of weeks. Constrictive pericarditis happens when a chronically increased pericardial sac twigs to the heart sinew, compressing it constricting it. A CT or MRI scan can furthermore help to identify chronic or constrictive pericarditis, by displaying the condensing of the pericardial coating affiliated with these conditions. Potential causes of cardiac perforation encompass centered line placement, pacemaker insertion, cardiac catheterization, sternal skeletal part marrow biopsies, and pericardiocentesis.

Pericarditis generally happens in flare-ups, but it may be the giving manifestation. Constrictive pericarditis is a very tough therapeutic problem. Diuretics may be utilised to eliminate surplus fluid built up in the pericardial sac. Bacterial pericarditis should be treated with antibiotics. Fungal pericarditis is treated with antifungal agents. Medicines, for example aspirin, ibuprofen, or other nonsteroidal anti-inflammatory pharmaceuticals (NSAIDs), are routinely utilised to organise the agony and inflammation. Acute inflammatory pericarditis generally lasts one to three weeks and doesn’t lead to farther problems. About 20 per hundred of pericarditis patients have a recurrence inside months or, seldom, inside years. Pericarditis is treated with bed rest, diuretics, and digitalis, but definitive remedy needs surgery to narrow piece the condensed pericardial coating from the heart.

Causes of Pericarditis, Acute

Acute pericarditis can be the effect of viral or bacterial infections. Other illness, mostly tuberculosis or fungal illness, can generate congealing and disfigurements of the pericardium and constrictive pericarditis. Rheumatic feverishness can generate acute pericarditis. Many other disorders deduce pericarditis as a supplemental symptom. These disorders embrace such things as systemic lupus erythematosis and chronic kidney failure. Pericarditis can deduce as a problem of a heart assault, a problem of heart surgery and as a problem of box with a seal damage or surgery. Cancer may distribute to the pericardium from other sites. Certain prescription medicines and release of energy therapy may generate pericarditis.

Signs and Symptoms of Pericarditis, Acute

Acute pericarditis creates box with a seal pain. Like a heart assault, the hurt may radiate into the neck or left arm. At times, the hurt may radiate into the back or higher abdomen. Typically, the hurt worsens with motion and facilitates when squatted up or slanting forward. Acute pericarditis can lead to quick inhaling, shortness of inhalation and cough. Fever and chills may develop. Constrictive pericarditis can limit the skills of the heart to extend and top up with blood. This can lead to generalized fault, physical exercise intolerance and graded fatigue. In augmentation, acute pericarditis can lead to the development of large measures of fluid in the pericardial sac. This fluid, like constrictive pericarditis, can limit the skills of the heart to function.