Pericarditis is an inflammation of the pericardium that commonly affects men aged 20-50. It has several causes including viral or bacterial infections, certain cancers, autoimmune diseases, or physical trauma. Symptoms include chest pain that increases with deep breathing or lying flat. Diagnosis involves electrocardiograms, echocardiograms, and blood tests. Treatment focuses on reducing inflammation with medications like aspirin, ibuprofen, or colchicine. Surgery may be required in severe cases to drain fluid or remove the pericardium.

1. PERICARDITIS
PRESENTED BY
R.PRIYA

2. INTRODUCTION
The incidence of acute pericarditis is approximately 27.7 per 100,000
individuals annually. The recurrence of disease is seen in almost 30%
of patients after first episode. The mortality rate of acute pericarditis is
approximately 1.1% in developed countries. Patients of all age groups
may develop acute pericarditis. Although it commonly affects men in 20 to 50
years of age. Pericarditis in developed countries is most commonly due
to malignancy or viral infection. It usually follows respiratory infections, most
commonly echovirus or coxsackie virus. In children, it is most commonly
caused by adenovirus or coxsackie virus. In developing
countries pericarditis is
usually secondary to tuberculosis or HIV infection. Tuberculous pericarditis,
caused by Mycobacterium tuberculosis, is found in approximately 1% of
all autopsied cases of TB and in 1% to 2% of instances of pulmonary TB

3. DEFINITION
Pericarditis is an inflammation of the pericardium.The condition usually clears
up after 3 months, but sometimes attacks can come and go for years.When you
have pericarditis, the membrane around your heart is red and swollen, like the
skin around a cut that becomes inflamed. Sometimes there is extra fluid in the
space between the pericardial layers, which is called pericardial effusion.
Pericarditis can affect anyone, but it is most common in men aged 16 to 65.

4. TYPES
according to the pattern of symptoms and how long symptoms last.
•Acute pericarditis begins suddenly but doesn't last longer than three
weeks. Future episodes can occur. It may be difficult to tell the difference
between acute pericarditis and pain due to a heart attack.
•Recurrent pericarditis occurs about four to six weeks after an episode of
acute pericarditis with no symptoms in between.
•Incessant pericarditis lasts about four to six weeks but less than three
months. The symptoms are continuous.
•Chronic constrictive pericarditis usually develops slowly and lasts
longer than three months.

5. TYPES
Pericarditis Based on Causes
 Constrictive pericarditis
When the pericarditis is associated with a thickening or scarring of the
pericardial layers, this starts constricting the heart within the thoracic cavity,
which in turn limits its effective functioning. This condition is known as
constrictive pericarditis.
 Pericardial effusion
In a normal person, the pericardial cavity is filled with about 20–50 ml of
fluid. Sometimes, in patients with specific medical conditions (for example,
severe hypothyroidism or kidney failure), or in those who have undergone
invasive cardiac procedures, there may be a gradual accumulation of fluid
within the pericardial cavity.
Such gradual fluid accumulation may often be asymptomatic until the
surrounding structures (lung, stomach, phrenic nerve) start getting
compressed, in which case symptoms related to such compressions (for
example, dyspnea, nausea, fullness of the abdomen) may manifest.

6. TYPES
 Cardiac tamponade
Steady pericardial effusion can cause the pericardial fluid volume to increase up
to 80 ml, or even 200 ml. Such high rises in the pericardial fluid volume can lead
to malfunction of the pericardium; therefore, this condition has to be treated as
an emergency.
 Viral pericarditis
Viruses that may cause viral pericarditis include coxsackieviruses, influenza
virus, agents of viral enteritis, human immunodeficiency virus (HIV), and
echovirus. Infection in the upper airways is the early symptom upon the onset of
this ailment. This kind of pericarditis is simple and can be handled as an
outpatient procedure.
 Purulent pericarditis
This is a rare disease caused by aerobic and anaerobic bacteria. Before the
discovery of antibiotics, pneumonia was believed to be the main cause of this
infection. Recent studies show that procedures such as surgery in the chest
region, hemodialysis, immunosuppression, and chemotherapy are dominant
causes that lead to this type of pericarditis.

7. TYPES
 Tuberculous pericarditis
This condition is also seen in a very minor percentage of patients having
pulmonary tuberculosis. Some of the developing countries remain the leading
risk groups of tuberculous pericarditis. Another population at risk is HIV-positive
patients. There is a gradual progression in symptoms of night sweats, dyspnea,
fever, and chill, but any suspected patient needs to be given emergency
treatment in the hospital.
 Radiation Pericarditis
This type of pericarditis is caused due to recent mediastinal radiation at any time
from weeks to months after the exposure.
 Traumatic pericarditis
Sharp or blunt trauma causes traumatic pericarditis. Invasive cardiac procedures
also may give rise to this type of pericarditis, which includes cardiac diagnostic
catheterization and electrophysiological ablation procedure.
 Malignancy
Malignancy pericarditis is mainly caused by metastatic (i.e. spread of cells to new
areas of the body) disease. It is common in metastasized bronchogenic or breast
carcinoma, Hodgkin’s disease and lymphoma, albeit it is rare in primary
mesothelioma and angiosarcoma.

8. CAUSES
The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to
50 years.
Pericarditis is often the result of an infection such as:
•Viral infections that cause a chest cold or pneumonia
•Infections with bacteria (less common)
•Some fungal infections (rare)
The condition may be seen with diseases such as:
•Cancer (including leukemia)
•Disorders in which the immune system attacks healthy body tissue by mistake
•HIV infection and AIDS
•Underactive thyroid gland
• Rheumatic fever
• Tuberculosis infections
•Heart surgery
•Heart attack

9. CAUSES
•Tumors
•Autoimmune disease(such as rheumatoid arthritis, lupus, or scleroderma )
•For some people, no cause can be found.
Other causes include:
•Heart attack
•Heart surgery or trauma to the chest, esophagus, or heart
•Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid can
cyclosporine, hydralazine, warfarin, and heparin, and some drugs used to treat cancer or
suppress the immune system
•Swelling or inflammation of the heart muscle
•Radiation therapy to the chest
•. injury to the chest, such as after a car accident (traumatic pericarditis), other health
problems such as kidney failure (uremic pericarditis), tumors, genetic diseases such as
Familial Mediterranean Fever (FMF), or rarely.

10. PATHOPHYSIOLOGY

11. SIGNS AND SYMPTOMS
Chest pain is almost always present. The pain:
•May be felt in the neck, shoulder, back, or abdomen
•Often increases with deep breathing and lying flat, and may increase with
coughing and swallowing
•Can feel sharp and stabbing
•Is often relieved by sitting up and leaning or bending forward
You may have fever, chills, or sweating if the condition is caused by an
infection.
Other symptoms may include:
Ankle , feet, and leg swelling
Anxiety
Breathing difficulty when lying down
•Dry cough
•Fatigue

12. DIAGNOSTIC EALUTION
History collection
Physical examination
doctor will listen to your heart. Pericarditis can cause a rubbing or creaking sound, caused by the rubbing of the
inflamed lining of the pericardium.This is called the “pericardial rub” and is best heard when you lean forward,
hold your breath and breathe out. Depending on how bad the inflammation is, your doctor may also hear crackles
in your lungs, which are signs of fluid in the space around the lungs or extra fluid in the pericardium.
Laboratory values can show
increased urea (BUN), or increased blood creatinine in cases of uremic pericarditis. Generally, however,
laboratory values are normal, but if there is a concurrent myocardial infarction (heart attack) or great stress
to the heart, laboratory values may show increased cardiac markers like Troponin (I, T), CK-
MB, Myoglobin, and LDH1 (lactase dehydrogenase isotype 1),increased WBC,esr increased,CRP
Increased
ECG,
Findings which may demonstrate a 12-lead electrocardiogram with diffuse, nn-specific, concave
("saddle-shaped"), ST-segment elevations in all leads except aVR and V1 and PR-segment depression
possible in any lead except aVR; sinus tachycardia, and low-voltage QRS complexes can also be seen if
there is subsymptomatic levels of pericardial effusion. The PR depression is often seen early in the
process as the thin atria are affected more easily than the ventricles by the inflammatory process of the
pericardium.

13. DIAGNOSTIC EVALUATION
•Chest X-ray to see the size of your heart and any fluid in your lungs.
•Electrocardiogram (ECG or EKG) to look for changes in your heart rhythm. In about half of all patients with
pericarditis, the heart rhythm goes through a sequence of four distinct patterns. Some patients do not have any
changes, and if they do, they may be temporary.
•Echocardiogram (echo) to see how well your heart is working and check for fluid or pericardial effusion around the
heart. An echo will show the classic signs of constrictive pericarditis, including a stiff or thick pericardium that
constricts the heart’s normal movement.
•Cardiac MRI to check for extra fluid in the pericardium, pericardial inflammation or thickening, or compression of
the heart. A contrast agent called gadolinium is used during this highly specialized test.
•CT scan to look for calcium in the pericardium, fluid, inflammation, tumors and disease of the areas around the
heart. Iodine dye is used during the test to get more information about the inflammation.This is an important test
for patients who may need surgery for constrictive pericarditis.
•Cardiac catheterization to get information about the filling pressures in the heart.This is used to confirm a
diagnosis of constrictive pericarditis.
•Blood tests can be used to make sure you are not having a heart attack, to see how well your heart is working, test
the fluid in the pericardium and help find the cause of pericarditis. If you have pericarditis, it is common for your
sedimentation rate (ESR)and ultra sensitive C reactive protein levels (markers of inflammation) to be higher than
normal.You may need other tests to check for autoimmune diseases like lupus and rheumatoid arthritis.

14. MANAGEMENT
•Pain relievers. Pericarditis pain can usually be treated with over-the-
counter pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB,
others). Prescription-strength pain relievers also may be used.
•Colchicine (Colcrys, Mitigare). This drug reduces inflammation in the
body. It's used to treat acute pericarditis or if your symptoms tend to come
back. You should not take this drug if you have liver or kidney disease.
Colchicine can also interfere with other drugs. Your doctor will carefully
check your health history before prescribing colchicine.
•Corticosteroids. Corticosteroids are strong medications that fight
inflammation. Your doctor may prescribe a corticosteroid such as
prednisone if your symptoms don't get better with other medications, or if
symptoms keep returning.

15. MANAGEMENT
Surgeries or other procedures
If pericarditis causes fluid buildup around the heart, you may need drainage or
surgery. Treatments include:
•Pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small
tube (catheter) to remove and drain the excess fluid from the pericardial cavity.
You'll receive a numbing medication (local anesthetic) before the procedure. The
doctor uses ultrasound and echocardiogram images to guide the needle and
tube to the correct location in the body. This drain stays in place for several days
while you are in the hospital.
•Pericardiectomy. This surgery removes the entire pericardium. It may be done
if the sac surrounding your heart has become permanently rigid due to
constrictive pericarditis.