May 25, 2023 Author : Hélder Ribeiro What is the pericardium? The pericardium is a bag-shaped membrane t hat surrounds the heart and the large vessels that come and go from the heart (aorta, pulmonary artery and vein, and vena cava). It prevents the heart from rubbing against neighboring tissues and organs and protects it. The membrane that makes up the pericardium is twofold: The outermost part, or fibrous pericardium , has connections to some nearby structures, to fix the heart in its normal position, prevent its excessive distension and protect it; The innermost, or serous pericardium , which in turn has two layers: The parietal pericardium, which lies immediately under the fibrous pericardium; The visceral pericardium or epicardium that directly covers the heart; Between the parietal and the visceral pericardium is a closed cavity – the pericardial cavity – which contains a small amount of fluid – the pericardial fluid. The pericardial fluid acts as a lubricant and prevents friction between the layers during heart contractions. What is pericarditis? The name pericarditis is given to an inflammation and/or infection of the pericardium , which can have several causes, for example: Infections by microorganisms such as viruses and bacteria; Autoimmune diseases such as lupus and rheumatoid arthritis; Kidney failure; Thyroid diseases; Chest injuries; Acute myocardial infarction; Side effects of some medications, for example isoniazid and hydralazine, and thoracic radiotherapy treatments; Neoplasms, especially metastases. Sometimes it is not possible to identify the cause of pericarditis, so it is said that it is idiopathic or of unknown cause. Main symptoms The main symptoms of pericarditis include: Chest pain, which is the main symptom: Usually it gets worse when lying down and when breathing deeply or coughing It tends to improve when sitting and leaning the trunk forward. Difficulty breathing; Palpitations; Fever; Tiredness; Persistent cough; Edema. Diagnosis and treatment of pericarditis To make a diagnosis of pericarditis are considered: The present symptoms and the patient history; The results of the physical examination; The results of medical tests, such as the electrocardiogram and echocardiogram. The physicians most often involved in diagnosing pericarditis are cardiologists, internists, and general practitioners . As for its evolution, pericarditis can be: Acute, if inflammation lasts less than 4-6 weeks; Chronic, when inflammation persists for more than 3 months. The goal of pericarditis treatment is to relieve symptoms, resolve inflammation, and treat the cause (where applicable). Some patients with pericarditis can be treated at home, others require hospitalization. To alleviate symptoms and resolve inflammation, the initial treatment approach includes anti-inflammatory medicines, the choice of which depends on several factors, including the length of treatment required. For example, ibuprofen or acetylsalicylic acid can be used in short treatments and colchicine in longer treatments. Complications of pericarditis Complications of pericarditis are more frequent in the case of chronic pericarditis or when treatment is not done properly. They may include, for example: Constrictive pericarditis : when the elasticity of the pericardium decreases and it loses its ability to stretch, interfering with the functioning of the heart. Cardiac tamponade : when fluid accumulates in the pericardial cavity (pericardial effusion). The complications of pericarditis can be life-threatening and, therefore, in these cases, hospitalization is indicated. The treatment approach depends on the particularities of each case. Pericarditis, COVID-19 and COVID-19 vaccination Although rare, pericarditis can be a consequence of COVID-19, secondary to the body's intense inflammatory response to fight the infection and inflammation of the heart caused by the virus. The risk of pericarditis after the COVID-19 vaccine is low, being more frequent in young men and after the second dose of mRNA vaccines. References : Kenhub. Pericardium . Imazio M. Pericarditis (beyond the basics). www.uptodate.com Meet the cardiology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
