Acute pericarditis is a rapid onset inflammation of the pericardium, the membranous sac that surrounds the heart. It is the most common pericardial condition and usually has an infectious cause, especially viral. The inflammation causes edema, fibrin deposition, and infiltration of white blood cells.
Symptoms of Acute Pericarditis
Typical symptoms include:
- Sharp chest pain that worsens with breathing or coughing and improves when leaning forward.
- Dyspnea (shortness of breath).
If a pericardial effusion (fluid accumulation in the pericardium) occurs, symptoms may arise from compression of nearby organs:
- Dysphagia: difficulty swallowing.
- Cough: due to tracheal compression.
- Hiccups: due to phrenic nerve irritation.
- Dysphonia: hoarseness due to compression of the laryngeal nerve.
- Abdominal pain: due to pressure on digestive organs.
- Cardiac tamponade: in severe cases, with symptoms such as intense shortness of breath, fatigue, and general discomfort. It is a medical emergency.
Diagnosis of Acute Pericarditis
Diagnosis is based on:
- Auscultation: presence of pericardial friction rub, best heard when leaning forward.
- Blood tests: increased white blood cells, ESR, and C-reactive protein.
- Electrocardiogram: ST segment elevation followed by T wave inversion.
- Chest X-ray: usually normal unless there is a significant effusion.
- Echocardiogram: useful for detecting effusions.
It is generally unnecessary to investigate the cause if a viral etiology is suspected, as it is the most common.
Treatment of Acute Pericarditis
In most cases, acute pericarditis improves with anti-inflammatory treatment within 1 or 2 weeks. Options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, indomethacin, ibuprofen.
- Colchicine: to reduce inflammation and prevent recurrences.
- Corticosteroids: if the effusion persists and infections such as tuberculosis have been ruled out.
- Antibiotics: if a bacterial cause is confirmed.
Pericardiocentesis (removal of pericardial fluid with a needle) is only performed if:
- The effusion causes cardiac tamponade.
- The effusion is persistent, and its cause is unknown.
- Purulent pericarditis is suspected (presence of fever, sepsis, or immunocompromised patients).
In most cases, the prognosis is favorable with proper treatment and medical follow-up.
