What are the symptoms of acute pericarditis?

Written by Liu Ying
Cardiology
Updated on August 31, 2024
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Acute pericarditis is an acute inflammatory disease of the visceral and parietal layers of the pericardium. The most common causes are viral infections and bacterial infections, but autoimmune diseases and uremia can also cause acute pericarditis. Characteristic pain behind the sternum or in the precordial area is common during the fibrinous exudative phase of the inflammation. This pain is associated with respiratory movements and often worsens with coughing, deep breathing, changes in body position, or swallowing. The nature of the pain is very sharp and can radiate to the neck, left shoulder, left arm, or even the upper abdomen. As the condition progresses, symptoms can shift from the fibrinous phase pain to dyspnea during the exudative phase. Some patients may develop significant pericardial effusion, leading to cardiac tamponade, and subsequently exhibit a range of related symptoms, including dyspnea and edema.

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Tuberculous pericarditis differential diagnosis

The differential diagnosis of tuberculous pericarditis requires differentiation from other types of pericardial inflammation, such as bacterial pericarditis and nonspecific infections that lead to cellular inflammation of the pericardium. In addition to infections that can cause pericarditis, other infectious diseases such as subacute endocarditis and infections caused by other microbes can also lead to pericarditis. Furthermore, some rheumatic autoimmune diseases can also present with pericarditis. It is necessary to perform pericardiocentesis and fluid examination to determine the specific cause.

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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis depend on the cause, as well as early diagnosis and correct treatment. For various types of pericarditis, such as those presenting with tamponade syndrome, pericardiocentesis should be performed to relieve symptoms. Tuberculous pericarditis, if not actively treated, can evolve into chronic constrictive pericarditis. Patients with acute nonspecific pericarditis and post-cardiac injury syndrome may experience recurrent pericarditis after their initial episode, which is the most challenging complication of acute pericarditis. Clinically, it presents similarly to acute pericarditis, with recurrent episodes months to years after the initial onset, accompanied by severe chest pain. Most patients can be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering to normal over several months. If ineffective, corticosteroid therapy may be administered. (Medications should be used under the guidance of a doctor according to specific circumstances.)

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How is acute pericarditis classified?

Acute pericarditis is classified according to the course of the disease, including acute fibrinous pericarditis and acute exudative pericarditis. If classified according to the cause, it can be divided into infectious pericarditis and non-infectious pericarditis. Infectious pericarditis can be caused by viruses, bacteria, tuberculosis, fungi, etc., while non-infectious pericarditis can be seen in tumors, uremia, acute myocardial infarction, aortic dissection, connective tissue disease, trauma, and cardiac surgery, etc. Acute pericarditis is an acute inflammatory disease of the pericardium's parietal layer, and its occurrence requires timely diagnosis. It is also important to further clarify the specific cause of acute pericarditis and actively treat it.

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acute pericarditis clinical manifestations

The clinical manifestations of acute pericarditis include symptoms and signs. The symptoms of acute pericarditis are pain behind the sternum and in the precordial region, which often occurs during the fibrinous exudative phase of inflammation. The pain can radiate to the neck, left shoulder, left arm, and even the upper abdomen. The nature of the pain is sharp, related to respiratory movements. As the condition progresses, the pain can disappear and be replaced by difficulty breathing. Some patients may develop significant pericardial effusion leading to cardiac tamponade, resulting in symptoms such as difficulty breathing, edema, and other related symptoms. During acute pericarditis, the most diagnostically valuable sign is the pericardial friction rub, typically located in the precordial area. A typical friction rub can be heard consistent with atrial contraction, ventricular contraction, and ventricular relaxation, known as a triphasic friction rub, and so on.

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Can acute pericarditis be cured?

Patients with acute pericarditis should identify the cause of pericarditis and treat accordingly, rest in bed until chest pain and fever subside, administer analgesics for pain relief, and if pericardial effusion occurs, administer corticosteroids for patients who do not respond well to other medications for absorbing effusion. In cases of excessive pericardial effusion leading to acute cardiac tamponade, immediate pericardiocentesis and fluid drainage are necessary. For persistent recurrent pericarditis lasting over two years, and in patients who cannot be controlled with steroids, or those with severe chest pain, surgical pericardiectomy may be considered as a treatment option.