Disease Description and Epidemiology
Pericarditis is a condition in which the pericardium gets inflamed. The pericardium is a sac that is fibro-serous that envelops the heart to protects and support it. Fever, chest pains, and an abnormally scratchy or raspy heart sound characterizes pericarditis. Notably, its occurrence is both chronic and acute forms. Pericardial tamponade is the life-threatening severity of pericarditis.
The inflammatory reaction causes fibrin, leukocytes, and platelets to accumulate between the pericardial sac’s visceral and parietal layers. The quantity of liquid that collects triggers various symptoms. The symptoms depend on the rate of accumulation. They also depend on whether the inflammation turns chronic or resolves at the end of the acute phase (Sommers, 2012). Amassing of fluid in the pericardial sac leads to severe pericardial effusion. The fluid interferes with the functioning of the heart when it applies pressure on the cardiac chambers. When the pericardial stiffens and thickens, acute inflammatory pericarditis progresses to chronic form. Chronic pericardial effusion is the progressive build-up of the pericardial sac’s fluid (Schub, 2018).
Etiology and Risk Factors
Viral or idiopathic cases of this disorder account for nine out of every ten cases. On the other hand, the likelihood of a patient with MI developing pericarditis is 0.07. Notably, the probability of a cardiac tamponade occurring is 60% for patients with purulent pericarditis. However, it only occurs in 15% of patients having idiopathic pericarditis. Rheumatic fever and MI increase the risk of pericarditis. In immunosuppressed people, it may get caused by tuberculosis.
Common Causes
About 0.26 to 0.86 of individuals have pericarditis without a known cause getting established. Then there are three broad etiological categories of pericarditis. The first one is infectious pericarditis caused by a viral infection and TB (Katz & MaACR, 2019). Myxedema, sarcoidosis, uremia, and several other factors cause non-infectious pericarditis. The third pericarditis gets relayed to autoimmunity and hypersensitivity. Drugs like procainamide and injuries like Dressler’s syndrome also get counted as causes of pericarditis (Sommers, 2012).
Risk Factors
Besides idiopathic cause, fungal, viral, bacterial, and amoebic infections cause pericarditis. Other reasons are metabolic and inflammatory disorders such as rheumatic fever and hypothyroidism. Further origins are chest trauma resulting from penetration by a sharp object or misuse of the cardiac catheter. There are medications whose effects cause pericarditis as well, such as anthracyclines and penicillin. Finally, cardiothoracic surgery-related inflammation and upper torso radiation therapy are causative factors (Schub, 2018).
Age Impact
Pericardial disease does not affect a particular age. However, it is less frequent in children than in adults
Gender-Based Prevalence
Pericarditis is less common in females than in males.
Environmental Influence
At the moment, there lacks environmental considerations that relate to pericarditis.
Genetic Basis
Despite the presently unknown genetic contributions of pericarditis, recurrent is a heritable problem (Katz & MaACR, 2019).
Lifestyle Influences
TB is the common cause of pericarditis in nations that are developing. On the contrary, developed countries have malignancy as the leading cause of pericarditis. It usually stems from pericardial effusions secondary (Sommers, 2012).
Pathophysiological processes
Rheumatic fever results from an unusual immune reaction when some strains of group A Streptococcus are untreated. The inflammations involve the heart, skin, and joints. Although it has become rare in recent years, new Streptococcus still makes it a threat. It causes the antecedent infection (Olivier, 2015). This antecedent infection comes as tonsillitis, strep throat, and pharyngitis. Consequently, the streptococcus organism antibodies form as expected. They react with collagen in the heart and skin, thus causing inflammation. It is during the acute stage that the heart’s inflammation involves heart layers. Hence, pericarditis occurs on the outer layer and, at times, includes effusion (Olivier, 2015).
Clinical Manifestations and Complications
Physical Signs and Symptoms
Weight loss, coughing, and low-grade intermittent fever show. Other symptoms, such as palpitations, night sweat, fever, and dysphagia accompany.
Signs and Symptoms
Among the sign and symptoms is a sharp, sudden substernal pain in the check. This pain then tends to radiate to the arms, back, neck or shoulders. The respiration varies the pain too. When one leans forward or sits ups, the pain lessens. It becomes worse when one lies down.
Complications
Among the possible accompanying complications are pericardial effusion and recurring pericarditis. The former one is whereby the fluid that accumulates between the pericardium and myocardium increases. Chronic constrictive pericarditis and non-compressive effusion also make up highly probable complications.
Implications When Untreated.
The mortality rate is close to 100% for patients who do not get treated for purulent pericarditis. This rate ranges from 40% to 12% upon receiving treatment.
Diagnostics
Common Laboratory and Diagnostic Tests
Diagnosis gets based on laboratory, imaging, and physical findings. There are several differential diagnoses. Pneumothorax, angina pectoris, and hepatitis are a few examples. In infectious pericarditis, CBC reveals rising WBC and ESR. Serum chemistry becomes handy in cases involving myocarditis as it points out great BUM and a little fractional increase of creatinine phosphokinase-MB. While the antinuclear antibody evaluates rheumatoid factor and SLE, rheumatic fever gets assessed by antistreptolysin. Tuberculosis assessment uses a PDP skin test (Schub, 2018).
Significance of Test Findings
The severity and etiology dictate the treatment approach taken. For example, bacterial pericarditis is severe and gets associated with high mortality. It occurs during a complication of a thoracic surgery or secondary to other infections. Contrarily, colchicine, and aspirin are treatments for uncomplicated pericarditis cases (Schub, 2018). For severe cases of constrictive and recurrent pericarditis, total pericardiectomy is the treatment. On the other hand, recurrent pericarditis gets treated by partial pericardiectomy. The underlying cause determines the prognosis, and patients can recover in at least three weeks.
In conclusion, pericarditis is an inflammation of the pericardium. The amount of fluid that accumulates determines the symptoms. Rheumatic fever increases the risk of pericarditis. It occurs mostly in adults and males. TB and malignancy are the respective leading causes in developing and developed countries. The complication involved are its recurrence as well as excessive build-up of fluids. Finally, the etiology and severity of pericarditis defines its treatment.