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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Written by Liu Ying
Cardiology
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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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Written by Tang Li
Cardiology
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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.

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Written by Liu Ying
Cardiology
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Symptoms of acute pericarditis

Acute pericarditis is an acute inflammatory disease of the visceral and parietal layers of the pericardium, with the most common cause being viral infections. The hallmark of acute pericarditis is pain in the precardiac area behind the sternum. The nature of the pain is very sharp, typically occurring during the fibrinous exudation phase of inflammatory changes, caused by friction between the visceral and parietal layers of the pericardium. The pain can radiate to the neck, left shoulder, and even the upper abdomen. It is associated with respiratory movements and often worsens with coughing, deep breathing, or changing body positions. When fluid exudes into the pericardium, separating the visceral and parietal layers, the patient's pain may decrease or disappear. However, some patients may experience symptoms such as breathing difficulties and edema due to cardiac tamponade.

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Written by Tang Li
Cardiology
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What are the types of pericarditis?

Pericarditis includes primary infectious pericarditis, as well as non-infectious pericarditis caused by related diseases, such as tumors, metabolic diseases, autoimmune diseases, and uremia. Based on the progression of the condition, pericarditis can also be divided into acute pericarditis, with or without pericardial effusion, chronic pericarditis, adhesive pericarditis, subacute exudative constrictive pericarditis, and chronic constrictive pericarditis. Clinically, acute pericarditis and chronic constrictive pericarditis are the most common.

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Written by Xiong Hong Hai
Infectious Disease
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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.