Pericardial disease otherwise known as pericarditis is a cardiac condition in which the layers of the pericardium which surrounds the heart, becomes inflamed due to an infection, heart surgery or a heart attack among others. Pericarditis can be acute or chronic and when left untreated may lead to permanent thickening, scarring and contraction of the pericardium known as constrictive pericarditis which affects the functioning of the heart. Cardiac tamponade may also develop if excess fluids collect and cause dramatic drops in blood pressure.
When present, depending on the type, symptoms of pericarditis may include:
- sharp and piercing chest pain over the centre or left side of the chest
- shortness of breath when reclining
- heart palpitations
- rapid heartbeat
- low-grade fever
- weakness and fatigue
- swelling of the legs, feet and abdomen
If left untreated, constrictive pericarditis may have developed, and the following symptoms may be experienced:
- extreme shortness of breath
- severe fatigue
- symptoms of heart failure such as persistent cough or wheezing, coughing up of pink mucus and unexplained weight gain
Diagnosis & Treatment
In order to diagnose pericarditis, Dr Ho may do a physical exam followed by a range of diagnostic tests which may include an electrocardiogram (ECG) or exercise stress test. This can be used to evaluate the electrical activity generated by the heart when it is at rest and when exercising. An echocardiogram which takes ultrasound images of the heart may also be done to check the blood flow of the heart. Your cardiologist may also use a CT scan and MRI of the heart to get detailed images of the heart and condition of the pericardium.
Because pericarditis can lead to long term complications, treatment will be aimed at preventing these complications by managing the inflammation and swelling of the pericardium. Aside from pain relieving medications, colchicine and corticosteroids may be used to reduce inflammation. When a bacterial infection is the underlying cause of pericarditis, treatment will involve antibiotics.
If constrictive pericarditis is diagnosed, Dr Ho may treat it with anti-inflammatory agents as well as diuretics to treat heart failure symptoms. If abnormal heart rhythm is present, antiarrhythmics may be prescribed.
In more severe cases where constrictive pericarditis or cardiac tamponade has developed, surgery will be needed. Surgical treatment may be done with a pericardiocentesis or pericardiectomy. During a pericardiocentesis, a catheter is used to drain the excess fluid from the pericardial cavity. In other cases where a pericardiectomy is used, the pericardium is removed so that the heart can pump efficiently.