Tuesday, 20 May 2025

Pericardial Disease Demystified: The Hidden Danger Lurking Around the Heart

Pericardial disease refers to conditions affecting the pericardium, which is the double-layered sac surrounding the heart. This sac protects the heart and reduces friction during heartbeats. Pericardial diseases can lead to significant cardiovascular complications if untreated.


Types of Pericardial Diseases

  1. Pericarditis

    • Inflammation of the pericardium.

    • Causes: Viral infections (most common), bacterial infections (like TB), autoimmune diseases (e.g., lupus), post-heart attack (Dressler's syndrome).

    • Symptoms: Sharp chest pain (worsens when lying down), fever, pericardial friction rub (heard on auscultation).

  2. Pericardial Effusion

    • Accumulation of fluid between the two layers of the pericardium.

    • Can result from pericarditis, cancer, trauma, kidney failure.

    • May lead to cardiac tamponade if fluid compresses the heart.

  3. Cardiac Tamponade

    • A life-threatening condition where fluid buildup compresses the heart and prevents it from filling properly.

    • Symptoms: Hypotension, distended neck veins, muffled heart sounds (Beck's triad), shortness of breath.

    • Treatment: Emergency pericardiocentesis (removal of fluid).

  4. Constrictive Pericarditis

    • Chronic thickening and scarring of the pericardium, which restricts heart movement.

    • Often follows repeated or untreated pericarditis.

    • Symptoms: Fatigue, swelling (especially in legs and abdomen), ascites, Kussmaul's sign (JVP increases with inspiration).

    • Treatment: Pericardiectomy (surgical removal of the thickened pericardium).

Diagnosis

  • Electrocardiogram (ECG): Can show changes suggestive of pericarditis (e.g., ST elevation, PR depression).

  • Echocardiography: Detects fluid, thickening, or compression.

  • Chest X-ray & CT/MRI: May show an enlarged cardiac silhouette or calcifications.

  • Blood tests: For inflammation (e.g., CRP, ESR) and infection.

Treatment Overview

  • Pericarditis: NSAIDs (e.g., ibuprofen), colchicine, corticosteroids in severe cases.

  • Pericardial Effusion/Tamponade: Pericardiocentesis or surgical drainage.

  • Constrictive Pericarditis: Pericardiectomy if symptoms are severe and persistent.




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