The heart is a muscle covered and protected by a “bag”, known as the pericardium. If this structure undergoes an inflammatory process, pericarditis is present. But what impact does it have on heart function and cardiovascular well-being? We asked doctor Daniela Pini, Humanitas’ doctor of internal medicine and cardiologist.
The pericardium consists of two membranes separated by a thin layer of liquid. When pericarditis develops, the two membranes ignite and the amount of liquid separating them can increase, and in some cases compress the heart.
A heart attack can also cause it
Pericarditis is, in most cases, caused by viral infection, whereas in rare cases it can be caused by bacteria or other pathogenic organisms. Inflammation of pericardium may also result from other diseases such as tumors, kidney failure or autoimmune diseases such as systemic lupus erythematous.
Can pericarditis be a consequence of cardiovascular disease? “Inflammation of the pericardium can rarely be the result of myocardial inflammation,” says Dr. Pini. In this regard, Dressler syndrome is mentioned. However, this was more often the case in the past, before the advent of reperfusion therapy, because pericarditis occurs more easily in the case of extensive heart attacks. Nowadays, since infarctions are usually readily subjected to reperfusion therapy, it rarely happens that they induce inflammation of the pericardium. Another scenario in which this can arise is after surgical operations in which the pericardium is cut, as is typically the case in cardiac surgery: the lesion of the pericardium can in fact trigger an autoimmune reaction”.
The cause of pericarditis – whether or not of infectious origin – will be decisive in the choice of treatment.
Pericarditis as heart failure
Among men and women, men are the most affected. The most typical symptom of acute pericarditis is chest pain: “However, it is a different form of pain than a heart attack. It is thoracic but tends to change, for example, with breathing, coughing and worsening when lying down,” the specialist points out.
The problem with pericarditis is that, once the inflammation has been resolved, it may recur again (recurring pericarditis), although it is rarely chronic. If inflammation causes the rapid accumulation of a large amount of fluid in the untensionable pericardial sac, the heart is “compressed” and can no longer fill up with blood: it is in the presence of cardiac plugging, which is a medical emergency. If fluid buildup occurs slowly and/or the inflammatory process leads to thickening and stiffening of the pericardium, the result is that the heart can no longer expand adequately, but the clinical picture is less dramatic.
There is no direct damage to the heart muscle, but the “sack” prevents the heart from filling and pumping blood, creating a picture comparable to that of heart failure. The symptoms are the same, starting with edema of the lower limbs,” adds Dr. Pini.
