What is pericarditis?

The pericarditis is an inflammatory disease of the connective tissue that surrounds the heart. The pericardium holds the heart in position, protects it from overstretching during its pumping work and keeps possible pathogens away. The pericardium, the pericardium, consists of two layers (leaves) and the pericardial cavity in between, in which there is fluid. It is normals for there to be water in the pericardium.

However, the amount of fluid in the pericardium can increase significantly. Doctors then speak of a pericardial effusion or pericardial effusion. Medically, the inflammation of the pericardium is also called pericarditis.

Doctors differentiate depending on the duration and course of the pericardial inflammation:

• Acute pericarditis : it lasts for up to three weeks. The causes can be infections with viruses, bacteria and other pathogens. But certain underlying diseases are also possible, for example heart, kidney or rheumatic diseases.
• Chronic pericarditis : This form is insidious and lasts for more than three months. The reason may be acute pericarditis that has not healed and that flares up again. Existing diseases can also promote chronic pericarditis. Over time, chronic pericardial inflammation can turn into constrictive pericarditis . The pericardium becomes increasingly calcified and scarred - it becomes thicker, more immobile and constricts the heart muscle. Panzerherz, that's why doctors say it.

Pericarditis: symptoms

Pericarditis can be acute or chronic . The pericarditis symptoms can be very different and also differently pronounced. Sometimes the disease is mild and people do not notice it. Acute pericarditis, on the other hand, can trigger very severe symptoms that are life-threatening and can even lead to heart failure.

Both forms of the disease have in common that the amount of fluid between the two layers of tissue increases to a greater or lesser extent - doctors speak of a pericardial effusion. Then the heart's pumping capacity drops because the heart can no longer expand sufficiently and the ventricles can no longer fill properly with blood.

Acute pericarditis: symptoms

An acute pericarditis you realize, for example, the following signs:

• Pain in the heart area (behind the sternum, entire chest); they can radiate into the left arm, shoulders, and neck; The intensity of the pain also often depends on the posture and breathing: it increases when moving, lying down, breathing deeply, coughing or swallowing. You will improve if you sit or lean your upper body forward.
• Chest pressure, chest tightness
• rapid fatigue and exhaustion
• Fatigue, weakness, loss of performance, general feeling of illness
• Fever , chills
• Shortness of breath, shortness of breath
• sometimes cough
• Swelling of the legs (edema)
• Palpitations , palpitations
• Drop in blood pressure
• Blood congestion in the neck vessels
• Decreased blood flow to the organs - if the kidneys are affected, for example, the amount of urine decreases
• Circulatory failure, shock

Chronic pericarditis: symptoms

A chronic pericarditis often is gradual and remain unnoticed for long. Over time, the pericardium becomes calcified, scarred, thickened and stiffened - it becomes more and more immobile and the heart hardly has any space to pump. Doctors speak of "armored heart" or constrictive pericarditis.

Doctors recognize chronic pericardial inflammation by:

• The blood visibly accumulates in the neck veins - they stand out clearly
• Congestion in the hepatic veins, enlargement of the liver
• Spleen congestion
• Water retention in the legs (edema)
• Water retention in the abdominal cavity (ascites)
• reduced performance, pronounced fatigue and exhaustion
• Feeling sick
• Racing heart
• Difficulty breathing during physical exertion, later also at rest

Always see your GP if you haves these and other symptoms suggestive of heart disease. It could be due to pericarditis. If you suspect this, your family doctor will refer you to a heart specialist (cardiologist) .

Pericardial tamponade: symptoms

A pericardial tamponade compresses the heart slowly or quickly because blood, pus, or fluid builds up in the pericardium. The heart can no longer properly expand during its pumping action. This is always an emergency and can be life threatening .

Signs of a pericardial tamponade can include:

• Low blood pressure - with pronounced pericardial tamponade, the systolic blood pressure drops by more than 10 mmHg when you inhale. "Pulsus paradoxus" is the technical term for it. In the further course the pulse can even disappear completely.
• Racing heart
• Shortness of breath
• greatly dilated neck veins

Pericarditis: treatment

The treatment of pericarditis always depends on the cause and the course. Doctors treat acute pericarditis differently than chronic pericarditis or armored heart. In addition, pericarditis therapy depends on the type (e.g. blood, pus) and amount of fluid that has accumulated in the pericardium. Doctors sometimes have to treat pericarditis in the clinic. The so-called pericardial tamponade is an acute emergency in which the pericardial inflammation can be fatal. Outpatient therapy is only possible if the risk is low.

Pericarditis: treatment with medication

The following drugs are available to treat acute pericarditis:

• Antibiotics when the cause of acute pericarditis is bacteria. Antibiotics are ineffective against viruses.
• Antifungal agents (antifungal agents ) when fungi are the culprit.
• Anti-inflammatory and analgesic drugs : glucocorticoids such as cortisone, acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen, indomethacin or naproxen. Doctors also use colchicine .

Pericarditis: Treatment with surgery

• Pericardial puncture (Perikardpunktion) to eliminate the excess liquid. Doctors insert a fine hollow needle and a catheter into the pericardium and suck off the effusion.

• Operative drainage (for example, in the case of infectious pericardial inflammation): Here doctors open the pericardium through a small incision near the breastbone and place a drainage - they drain the fluid outwards through a small plastic tube. This procedure is called pericardiotomy.
• Pericardial windowing (in chronic pericarditis): This involves surgeons opening the chest and then the pericardium as part of an operation. You remove a piece of the pericardium and create a permanent "window". This allows the fluid to drain into the pleural cavity (a small gap between the two sheets of the pleura) and is absorbed there. This corresponds to a kind of "internal drainage".
• (Partial) removal of the pericardium of the armored heart (pericardectomy): Surgeons open the chest through an incision and remove the thickened or calcified pericardium in whole or in part. This creates space so that the pericardium does not constrict the heart any further and it can work better again. Doctors should perform the operation as early as possible, before the heart muscle or the liver or kidneys are damaged.

Pericarditis is often related to other diseases, for example rheumatic diseases or heart and kidney diseases. Then pericarditis therapy also consists of treating these underlying diseases adequately.