Guide to Pericarditis and Pericardial Disease
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Reviewed by the physicians of Columbia’s Heart Surgery Team, December 2024
Pericarditis is an inflammation of the pericardium, the membrane forming the outer covering of the heart. The inflammation causes a thickening and roughening of the membrane and an accumulation of fluid in the sac surrounding the heart.
What is Pericarditis?
The pericardium is a double-walled sac filled with fluid that surrounds the heart and the roots of its major blood vessels. It serves several important functions: preventing the heart from becoming overfilled with blood, maintaining the heart's position within the chest cavity, and providing lubrication to reduce friction during heartbeats. When the pericardium becomes inflamed, it is known as pericarditis.
Pericarditis can have various causes and may occur suddenly. While it typically lasts several weeks, in some cases, it can persist for several months before resolving. It can affect anyone. In some instances, pericarditis can become chronic and resistant to conventional therapy, potentially leading to long-lasting stiffness of the pericardium (constrictive pericarditis). Additionally, flares of pericarditis can result in the accumulation of extra fluid within the pericardial sac (pericardial effusion).
What Causes Pericarditis?
The cause of pericarditis is wide. In many cases, the cause is unknown (idiopathic) or thought to be secondary to a recent viral illness that can be as simple common cold.
Other causes, although rare, are bacterial infections (including tuberculosis), fungal infections and other organisms. Some autoimmune diseases can involve pericarditis, and in some cases, it will be the first presentation of the autoimmune condition; lupus and rheumatoid arthritis are two common examples of autoimmune associated pericarditis.
Another common cause is pericardial layer injury, as seen in patients after heart surgeries (post-pericardiotomy syndrome) but can also be a result of percutaneous procedures such as ablation and more. Similarly, pericarditis can occur after heart attacks (myocardial infarction) and after heart injury. Other causes are secondary to genetic diseases, such as Familial Mediterranean Fever (FMF). Malignancy may complicate with pericarditis, with some cases secondary to radiation therapy or drug side-effects.
What are the Types of Pericarditis?
The most common type of pericarditis is acute pericarditis. Other types are defined based on how long symptoms last.
Types of pericarditis include:
- Acute pericarditis: This is the most common type, characterized by sudden onset and lasting a few weeks. Sharp chest pain, often resembling a heart attack, is the primary symptom. Episodes may recur.
- Recurrent pericarditis: This occurs approximately 4 to 6 weeks after an episode of acute pericarditis has resolved, with no symptoms between episodes. The risk of recurrence increases with the frequency of pericarditis episodes.
- Chronic pericarditis: This type lasts for three months or longer.
- Constrictive pericarditis: A complication of pericarditis, where the chronically inflamed pericardium becomes stiff and thickened, constricting and interfering with normal heart function. This condition typically arises from repeated episodes of pericarditis, though it can also be the initial presentation in some cases.
What are the Signs and Symptoms of Pericarditis?
The most common symptom is sharp, stabbing chest pain caused by the friction of the inflamed pericardium against the heart. The pain may worsen with deep breaths or lying flat and improve when sitting up and leaning forward. Other associated symptoms include fever, weakness, fatigue, and a dry cough. In complicated cases, swelling in the feet, ankles, and legs may be observed.
Pericarditis and the COVID-19 Vaccine
Rare cases of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the heart's outer lining) have been reported after mRNA COVID-19 vaccination from Pfizer-BioNTech or Moderna, particularly in male adolescents and young adults. Most patients with myocarditis or pericarditis felt better quickly after receiving medical treatment and resting.
Public health authorities recommend that everyone aged 6 months and older get vaccinated for COVID-19. It's important to understand that the risks of COVID-19 illness and its potential complications, hospitalization, and death are significantly greater than the risks of experiencing a rare adverse reaction to vaccination, including the risk of myocarditis or pericarditis.
The association between myocarditis and pericarditis is known and can be primarily driven by inflammation of the heart muscle with associated pericarditis or primary pericarditis with some involvement of the myocardium. Diagnosis is crucial, as it guides different treatment approaches and always requires an experienced medical provider.
What is the Treatment of Pericarditis?
The mainstay of therapy for idiopathic pericarditis involves anti-inflammatory medications to reduce pericardial inflammation and relieve pain. High doses of ibuprofen, aspirin, or other anti-inflammatory drugs are commonly used for an extended duration. Colchicine is another frequently prescribed anti-inflammatory medication that helps reduce recurrences. In resistant or recurrent cases, corticosteroids may be used.
Your provider may also discuss treatment with other agents that reduce inflammation, such as Anakinra and Rilonacept, IVIG, and Azathioprine. Therapy for other causes of pericarditis varies and is targeted for the primary reason.
Next Steps
If you have heart disease and need help, we’re here for you. Our Center for Myocarditis and Pericardial Diseases is a multidisciplinary clinic that includes a cardiologist specializing in myocarditis and pericardial diseases, a rheumatologist, a radiologist specializing in cardiovascular imaging, and a heart surgeon consulted in specific cases. This patient-focused approach aims to investigate the cause of pericarditis and guide treatment based on the results. The center focuses on achieving disease remission, reducing recurrences, and monitoring for complications of pericardial disease.
To get started today, call (212) 305-4600 or use our appointment request form.