Pericarditis

Pericarditis

Pericarditis refers to inflammation of the pericardium

The pericardium is a sac within which the heart sits. This sac has 2 layers- known as the visceral and parietal layers separated by a potential space which contains about 10-50mls of fluid. Acute inflammation of this sac is known as acute pericarditis. If the inflammation spreads to the surface of the heart itself, it is termed myopericarditis.

About 5% of patients who present to A+E with chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.

Why does this inflammation happen? There are a multitude of causes and the most common causes depend on which part of the world you are in. In developed countries the commonest cause of acute pericarditis is a presumed viral infection. Common viruses that have been identified include Parvovirus B19, EBV, CMV, Herpes Simplex Virus etc)  In developing countries, common causes of pericarditis are TB and HIV. Other common causes of pericarditis include bacterial infections, kidney failure, rheumatological conditions such as autoimmune conditions/vasculitis (SLE, rheumatoid arthritis, sarcoidosis) and even cancer (mesothelioma; spread from other tumors). Also recent cardiac surgery and a recent heart attack can present with pericarditis.

How does it present?

It may present out of the blue but quite often it may present after a flu like respiratory or gastric illness.

Pericarditis is characterised by often quite severe chest pain but it is usually reasonably easy to distinguish from anginal pain because in pericarditis,the pain is very sharp and actually catches the breath when a person tries to breath in. it is made worse when the patient coughs. It is characteristaiclly better when someone sits up and leans forward. This is because this position reduces the pressure on the paricardium. Pain is a feature in over 95% of patients. It is very prevalent in patients with an infection but may be not as painful in patinets with renal failure or rheumatological problems. The pain may radiate to the the trapezius ridge. 

One of the things that is very helpful to make the diagnosis of pericarditis is to listen to the heart is the presence of a pericardial friction rub. The 2 layers are both inflamed and as the heart moves within the pericardium these two layers rub against each other and can produce a scratchy or squeaky sound that can be heard by an experienced doctor. The absence of a rub does not exclude the possibly of pericarditis but the presence makes it very likely that that is what you are dealing with. To hear it your doctor should get you to lean forwards and hold your breath or even get you on your hands and knees and listen while you are in that position.

[gordongroves]

Hello,
I have Lupus and have recently had bilateral PE. My consultant has arranged for me to see a Cardiologist to address the pericarditis symptoms that I have. I found your video very comforting and reassuring, thank you.

[JesusIsAboveAllOtherNames]

I was diagnosed with pericarditis in 2004. Mine was caused by sepsis associated with iron toxicity. I had sepsis for 6 months until it was diagnosed. Whenever the infection spread to my heart, it caused scar tissue, which led to me having atrial tachycardia.

I hope nobody has to go through this, and none of you have to go through doctors mistreating you even though you tell them what's wrong and they won't listen to you. It's horrifying. Like you know you're dying, and you know your body is telling you, you tell the doctors what's going on and they just keep neglecting your symptoms.

Not all doctors are this way, but the ones who are traumatize patients, and sometimes they traumatize them for life.

Here I am in 2021, and they're doing the same thing to me while I'm septic again. Strangely enough, the infection started in my throat again. What are the odds? Crazy stuff for sure.

[alicepartosa]

My internet doctor is understanding and good hearted, too. Forget to mention, handsome as well.

[pineapplesandpancakes]

ive had recurrent pericarditis for several years. Great video, thank you

[pearl]

We should ‘bottle’ all you’re knowledge ! You!!! 💫!! You’re ‘Outstanding’ !!! You’re Patients are so lucky to have such an Incredible Consultant ! ( and so lovely to look at 🤭🙃) Adorable !

[ellenh]

You explain things so thoroughly and in ways most anyone can understand. From now on if anyone asks me a question (retired nurse) I'm just going to see if you've made a video on it before I try explaining it myself 😂 Save me some time. You really do teach well.

[LuigiDAmico-ge]

Deliberately Helpful, Frankly Informative, Most Instructive. THANK YOU.

[cocoM]

I was one of the people that asked you to do a video on this after having it last year, so thank you very much. You have put my mind at ease.

[nanette]

I so appreciate you...! You are so much better than my regular doctor. You explain things in a language that I understand. You explain why I should do something. I have noticed that you have not posted anything in almost 2 months. If you need a topic, I have just had a Pace maker implanted. It's in 2 chambers. Since then I have felt flutter for about 2 to 3 beats (only twice since June 21st.) but also for 1 heart beat I have felt something strange really quick and then it's gone. My Pulse rate was 33-34 bpm and now it's set for 65 bpm. Thank you for all you do

[brainteaser]

Thank goodness I found this! Was on the move when I became unwell and then had bouts of the very painful chest pain, so medical care from three different places and concerns about diagnosis and ongoing treatment. This answered all my questions and guided my decisions about what to do. Thank you 🙏🏻

[MarcSR]

Thank you very much for this great video, my girlfriend suffered from this condition, i am glad she is ok now.

[Overawe]

Your vidoes are Priceless, thank you !

[hennalondon]

Representing the Bengalis! Haha... watching from Australia after suffering ongoing heart palpitations following Pfizer. This was easy to understand and incredibly comforting as was your vaccine related video. Thank you so much tor taking the time to make these videos. Keep well.

[zerolefty]

I am 20 and have myocarditis and am struggling to get better even after 8 months of it, the pain is so bad. I am grateful that there are people like you that provide us with information on the heart and it’s problems so thank you.

[think]

I watch all your videos....and have not before commented on the effect.
Your knowledge is impressive, as is your ability to communicate...but most of all your sincerity, compassion and empathy tell me you are in the perfect profession for your natural as well as hard earned capabilities.
It brightens my world view to know there are genuinely good people doing good work for the right reasons.
Thank you!

[pierreforget]

Very useful to me! I had a pericarditis 3.5 years ago, following about 3 months of rhumatoidal pains (first, then they went away with natural products), then low fever all the time (even ibuprofen would not lower it completely), and a constant cough. I had a few intense chest pain a few times, but no real pain in general. My doctor and me were thinking of a pneumonia, but the treatment didn't really do anything. I lost 20 pounds, because I was not hungry, slept a lot. Finally, my wife told me: you're going to the hospital, you're too sick. In fact, the morning I went to the hospital, I did 15 minutes walk on the treadmill without much effort. They made a scan of the whole upper part of the body and found liquid around the heart (years after, I looked at the report, and then I got afraid: 2.6 cm thick of liquid!). They sent me to a cardiology department in Montreal where they eventually found out that it was cause by a Sjogren (similar to lupus, for people who are not familiar). One funny thing: I was 10 days in the hospital and they made a lot of tests, and many electrocardiograms. One day, I asked one of the doctor: you made a lot of electrocardiograms and you never gave me the results? He said it's because they were always good, because my heart cavity is big enough to let the heart pump without restriction. Good for me! But the inflammantion (PCR) was over 300! The cure was easy: they started prednisone at 50mg/day and then lowering it gradually over a period of roughly 2 months. 3 days after the beginning of the treatment, I was back at my normal activities (with care...) and the energy levels were up to almost normal. What I retain from your presentation is to really chek for symptoms if it ever comes back. Althought I am followed by a specialist for the Sjogren, I don't see him every week. So, it's good to know in advance just in case. I had that when I was 70 years old. Thank you again for this advice, it might be life saving for me!

[butterontoast]

My cardiologist says: Do this...
I say: but Dr. Gupta says... 😊

[newpatterns]

Thank you so much! I was diagnosed with pericarditis when I was 16. I am 24 now, and it’s been one hell of a ride. At first I didn’t take pericarditis serious, so I never treated it. That’s until I ended up in the hospital with almost 2 liters of fluid around my heart! I had a pericardial Centesis. Thank you again for your reassurance and spreading awareness of this terrible illness!

[brendanglennon]

Mary thanks for your many classes on heart conditions, very decent and human of you, best wishes to you and yours

[sandeepettit]

I had an ablation for atrial SVT. The next day, 911 went to hospital. Diagnosis was pericarditis.