The human heart has three layers- pericardium (the outermost fibrous sac like covering of the heart), myocardium (middle muscle layer of the heart that enables contractions), and endocardium (the inner lining of the chambers and valves of the heart). Any inflammation to these layers due to the body’s reaction to an infection or injury is medically classified as pericarditis, myocarditis, and endocarditis respectively. Any serious inflammation to the lining of the heart muscle and heart valves could cause arrhythmia, coronary heart disease and heart failure. Experts state that some symptoms like chest pain, shortness of breath, or fever may be common for all three kinds of inflammation.
Pericarditis
Pericarditis is the inflammation or infection of the pericardium which is the fibrous sac-like membrane surrounding the heart to help it work and hold it in place. Pericarditis can be both acute and chronic. “When inflammation in the pericardium occurs, fluid can accumulate, and is referred to as pericardial effusion (fluid collection),” says Dr Jyoti Kusnur, interventional cardiologist, Manipal Hospital, Goa. She adds that this is dangerous because if this happens, the fluid can compress the heart. This causes the output of the heart to go down as it is being compressed from the outside.
Dr Thejaswi N Marla, cardio-thoracic vascular surgeon, Fortis hospital, Chennai adds that this can cause inflammation of the tissues around the heart and obstruct blood supply leading to a more severe form of pericarditis called constrictive pericarditis.
Causes of pericarditis
Dr Marla explains that pericarditis can be caused due to infections, commonly viral but it could be bacterial and fungal as well. “People with viral infections may complain of chest pain sometimes. When we further check on the ECG, we find out that they have pericarditis,” says Dr Kusnur.
Tuberculosis, radiation, toxins and autoimmune conditions like lupus, rheumatoid arthritis, and scleroderma can also cause pericarditis.
It can also occur after a heart attack or a heart surgery, cancer, HIV/AIDS, tuberculosis, injuries, and intake of certain medicines (like phenytoin, warfarin, and heparin).
Symptoms of pericarditis
Experts state that pericarditis causes positional pain. “For instance, pain in the chest while deep breathing, or lying down which gets better when sitting up and leaning forward because the sac is not rubbing against anything,” says Dr Kusnur. She adds that this happens because pericardium is the outermost layer and depending on where it touches, the pain might increase. While deep breathing, the linings will rub against each other.
“Pericarditis causes edema or fluid retention in the body, more commonly in the lower part of the body (pedal edema),” says Dr Marla. Other common symptoms also include fatigue, fever, breathlessness, coughing, weakness, irregular heartbeat, shortness of breath, and tiredness.
Myocarditis
Myocarditis is the inflammation of the myocardium which is the thickest and muscular middle layer of the heart wall.
“In myocarditis, the heart muscles are either infected or do not get enough blood supply (due to the blockage of blood vessels),” says Dr Marla. He adds that due to this, the heart muscles get weakened causing reduced LV function (the left ventricle’s function is to pump oxygenated blood to the body), leading to LV failure or pump failure.
Causes of myocarditis
Experts state that myocarditis can be caused due to a bacterial (like strep), fungal (like candidiasis) or commonly a viral infection (such as cold or flu). It can also be drug induced (drugs like lithium). Dr Kusnur adds that any autoimmune disorders can cause myocarditis.
“Infections in other organs can also lead to myocarditis,” says Dr Marla. He adds that it could also be caused because of persistent tachycardia (increased heart rate), or due to long term comorbidities like diabetes and systemic inflammatory diseases.
Symptoms of myocarditis
Experts state that since myocarditis reduces the pumping function of the heart, one may experience symptoms of LV failure, like pedal edema (when fluid gathers in your feet and lower legs), and pleural effusion, which is the collection of fluid in the pleural cavity (space between the two membranes surrounding the lungs). “This leads to breathlessness because of fluid overload within and around the lungs,” says Dr Marla.
Experts add that other symptoms include difficulty consuming food, listlessness, body weakness, body ache, poor appetite, chest pain, weight gain because of fluid accumulation in the body, fatigue, fever, and light-headedness.
Endocarditis
Infective endocarditis or bacterial endocarditis is the inflammation of the endocardium, which is the inner lining of the chambers and valves of the heart. The bacteria enters through the bloodstream and infect a heart valve, the heart lining, or a blood vessel. “Since it is the innermost layer of the heart, if the endocardium is inflamed, the inflammatory masses can move to different parts of the body, causing embolism (blocking of the artery),” says Dr Kusnur.
Causes of endocarditis
Dr Marla explains that a rheumatic fever can cause inflammation of the endocarditis and usage of common needles can cause infective endocarditis.
Experts add that it can also be caused by any infections, heart valve disease or surgery, a congenital heart disease and intravenous drug use.
Symptoms of endocarditis
Dr Marla explains that endocarditis usually presents with the onset of fever, clubbing of nail bed, rash spots on the nail beds, low haemoglobin, poor appetite, poor sleep, and fatigue. Other symptoms include sweating, shortness of breath, prolonged fever or chills, heart murmur or abnormal heart sounds. Sometimes poor oral hygiene and periodontal diseases (gum infections) can also indicate infective endocarditis
“The person affected by these may also have the symptoms of cardiac failure because of the infection of the valve. This makes it difficult for them to do their regular activities,” says Dr Marla.
Takeaways
There are three main types of cardiac inflammation which could lead to serious heart complications if not treated on time. These conditions are called pericarditis, endocarditis and myocarditis and are caused due to the body’s inflammatory reaction to any infection or injury. Experts point out that regular health check up and following a healthy diet and active lifestyle along with effective diabetes management as some of the precautions.
