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Pericarditis: When the heart skips a beat
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Pericarditis: When the heart skips a beat

Undetected pericardial inflammation could be a precursor to serious heart complications, especially after physical exertion

Pericarditis: Undetected pericardial inflammation could lead to serious heart complications, especially after physical exertion

“It felt like a heart attack – severe shortness of breath and chest pain along with swelling in my legs. It was two days after I ran a marathon in October 2022,” recalls Brenda Morrow, a professor in the department of pediatrics and child health, University of Cape Town, during an online interaction with Happiest Health. She was rushed to the emergency room (ER) and was later referred to a cardiologist. The tests revealed that her heart rhythm was also off the charts apart from high blood pressure.

“The cardiac MRI report showed clear signs of edema (swelling) in the myocardium as well as a pericardial effusion (excess fluid build-up), leading to the diagnosis,” explains Morrow.

Morrow’s pericardium (a thin sac that protects the heart) and myocardium (the middle layer of the heart muscle) were both infected simultaneously. Fortunately, the problem was detected in time. If left untreated, the conditions could have led to serious cardiac issues including a heart attack.

What is pericarditis?

The heart consists of three different layers — pericardium (the fibrous sac-like membrane surrounding the heart), myocardium (thick, muscular middle layer of the heart wall) and endocardium (a layer which lines the inside of the chambers of the heart and forms the surface of the valves) which may get affected due to viral, bacterial or fungal infections.

“When the pericardium (the double-layered fibrous sac and the outermost covering of the heart) becomes infected and gets inflamed, the condition is known as pericarditis,” says Dr Divya Marina Fernandes, consultant, heart failure specialist and interventional cardiologist at Aster RV Hospital in Bengaluru.

The cavity between the twin layers of the pericardium is filled with a thin layer of fluid that lubricates the heart and cushions it from outside forces or injury.

Dr Mohit Singh Tandon, consultant and non-Invasive cardiologist at Fortis Escorts Heart Institute, Okhla, New Delhi says that pericardium inflammation can be accompanied by increased fluid collection within the pericardial sac, and this is known as pericardial effusion.

This excess fluid affects blood circulation and could lead to a drastic plunge in blood pressure and may trigger a heart attack. In constructive pericarditis, the severe version of this condition, the heart lining becomes thick and the blood supply gets obstructed.

According to an article published in the American Heart Association, the only cure for constrictive pericarditis is pericardiectomy (a procedure to remove the pericardium surgically) which is opted for in severe cases. It could take weeks or months to recover from chronic cases of pericarditis.

Types and symptoms of pericarditis

Dr Fernandes says that pericarditis can cause symptoms like:

  • fever
  • chest pain
  • breathlessness
  • fatigue
  • an irregular heartbeat

Incessant pericarditis is characterised by persistent symptoms for about four to six weeks despite therapy. In recurrent pericarditis, these symptoms appear on and off for about six weeks. Chronic pericarditis could persist for three months without any respite.

“Non-infectious pericarditis is caused by non-infectious factors like post-radiation therapy for cancer or in the case of kidney failure (uremic pericarditis) trauma, connective tissue conditions and other cancer-related issues,” explains Dr Tandon.

Idiopathic pericarditis is another variant of this condition caused due to unidentified factors.

Pericarditis: Who is at risk?

Pericarditis could affect people from any age group. People with a recent heart attack or an infection, and those with connective tissue disorders are at a higher risk.

The condition can be diagnosed with the help of an ECG, echocardiogram, blood tests, a troponin test (a kind of protein released when the heart is damaged) and other enzyme tests. Apart from viral infections, pericarditis could also be a complication of bacterial tuberculosis which could be difficult to diagnose, says Dr Tandon.

“I have been asked not to exercise for a while”

Prof Morrow started experiencing shortness of breath following a moderate Covid-19 infection in early 2022.  Initially, she consulted a physician and was prescribed a steroid-based inhaler; she was also told that she had no complications. “I was even cleared to start a running training program,” she says.

But her palpitations and shortness of breath gradually became worse after short bouts of exercise. When she was rushed to the ER in October, initial tests did not reveal any heart problems. Later, after a 72-hour continuous cardiac monitoring, it was revealed that the exercise sessions were affecting her heart rhythm, confirming the pericardial effusion and myocardial edema.

She has been strictly asked not to work out for a few months and put on anti-inflammatory medication. Prof Morrow is slated for medical review and imaging tests in February to assess the response to treatment.

Treatment

Pericarditis can be treated by managing the underlying cause with antiviral, antibiotics or heart failure medications, as required.

Dr Fernandes explains that those affected are prescribed pain relief medication. In some rare cases, the excess fluid in the pericardial space needs to be drained if it is putting life-threatening pressure on the heart.

Takeaways

Any signs of pain, breathlessness, palpitations and discomfort around the chest shouldn’t be brushed off. They need to be probed before they turn into a painful inflammation of the pericardium.

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