Pericarditis acute: Exploration, symptoms, causes, and additional insights
Acute pericarditis is a condition that affects the pericardium, the protective sac surrounding the heart. This inflammation, typically lasting fewer than 4 to 6 weeks, can be caused by various factors, including viral infections, recent digestive or respiratory system infections, and heart surgery [1, 2].
The American Heart Association (AHA) notes that acute pericarditis develops suddenly, and symptoms often include sharp, stabbing chest pain that generally comes on quickly, usually on the left or in the middle of the chest. Other symptoms associated with acute pericarditis include a dull ache or pressure in the chest, coughing, low-grade fever, weakness and fatigue, difficulty breathing when lying down, heart palpitations, swelling in the abdomen, legs, or feet [1, 2].
Healthcare professionals generally recommend nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine to treat acute pericarditis [1]. In cases of recurrent pericarditis, IL-1 inhibitors, such as ARCALYST (rilonacept), may be used to treat the condition and reduce the risk of future recurrences. ARCALYST is the only FDA-approved therapy for the treatment of recurrent pericarditis and reduction in risk of recurrence in adults and pediatric patients 12 years and older [2].
It is important to note that males are more likely to develop pericarditis, but it can affect people of any age or sex. However, if symptoms of possible complications of acute pericarditis return, such as coughing, weakness, difficulty breathing, and heart palpitations, immediate medical attention is necessary [1, 2].
The common complications associated with acute pericarditis primarily include pericardial effusion, cardiac tamponade, constrictive pericarditis, and chronic pericarditis.
Pericardial effusion occurs when fluid accumulates in the pericardial space. If left untreated, it can progress to effusive-constrictive pericarditis or heart failure symptoms [1, 3]. Cardiac tamponade is a life-threatening complication caused by rapid accumulation of fluid that compresses the heart, impairing its ability to pump effectively. Symptoms include Beck’s triad (hypotension, muffled heart sounds, jugular venous distension) [3, 4].
Constrictive pericarditis develops when the pericardium becomes thickened or fibrotic, restricting heart expansion and causing symptoms of heart failure such as peripheral edema, ascites, jugular venous distension, and fatigue [1, 3, 5]. Chronic pericarditis can follow unresolved acute pericarditis and may manifest as constrictive physiology or persistent inflammation.
Other complications include heart failure symptoms due to impaired cardiac filling and output [1, 3] and recurrence of pericarditis if not adequately treated [4]. These complications can be life-threatening without timely diagnosis and appropriate management, including NSAIDs, colchicine, and possibly pericardiectomy for refractory cases [1, 4].
In cases where chest pain is a concern, it is crucial to call 911 immediately to rule out the possibility of a heart attack. Patient education on symptom monitoring and follow-up is vital for early detection of complications [1].
In under-resourced countries, tuberculosis is the leading cause of acute pericarditis. Other possible causes include kidney failure, a heart attack, cancer, HIV and AIDS, injury due to an accident or radiation therapy, and taking certain medications such as warfarin, heparin, phenytoin, and procainamide [1, 2].
[1] American Heart Association. (2020). Acute Pericarditis. https://www.heart.org/en/health-topics/pericarditis/acute-pericarditis
[2] National Heart, Lung, and Blood Institute. (2020). Pericarditis. https://www.nhlbi.nih.gov/health-topics/pericarditis
[3] Mayo Clinic. (2020). Pericarditis. https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc-20375673
[4] Cleveland Clinic. (2020). Pericarditis. https://my.clevelandclinic.org/health/diseases/16964-pericarditis
[5] UpToDate. (2020). Acute Pericarditis Overview. https://www.uptodate.com/contents/acute-pericarditis-overview
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