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Chronic pericarditis can be described as a long-term or recurrent inflammation in the pericardium, which is the flexible, two-layered sac enclosing your heart. This sac performs the important functions of keeping your heart in place, protecting it against infections & preventing the buildup of excess blood in the heart. However, certain factors could result in the thickening of the pericardium or the accumulation of fluid in the pericardial space, which leads to the development of pericarditis.

This inflammation can be of two types - acute pericarditis, which occurs suddenly and is short-lived, and chronic pericarditis, where the symptoms develop gradually and last for more than 6 months.

Chronic pericarditis can be further divided into two types -

• Chronic effusive pericarditis: Fluid gradually builds up within the pericardial space, between both the pericardium layers.
• Chronic constructive pericarditis: Fibrous, scar-like tissues are formed throughout the pericardium, and as the tissues shrink they apply pressure on the heart.

It is possible to treat pericarditis, with the help of medication or surgery. Early diagnosis and treatment of the condition improve your chances of making a complete recovery.

Causes

In most cases, the exact cause of pericarditis is difficult to determine. Given below are some of the common factors that could lead to the development of this inflammation -

• Injuries or trauma, like a hard blow to the chest area, which may damage the sac
• Conditions, which include heart attacks, kidney failure, cancer & autoimmune diseases
• Medical procedures such as heart surgery or radiation therapy
• Microorganisms like bacteria or viruses that infect the sac
• Systemic inflammatory disorders, including lupus and rheumatoid arthritis
• Use of certain drugs especially those used to treat cancer, infections & hypertension

Many individuals develop this problem soon after they have suffered a major heart attack. Delayed pericarditis, also known as Dressler’s Syndrome, could occur several weeks after a major heart surgery or heart attack, because of the formation of antibodies.

Symptoms

The signs and symptoms of pericarditis may vary, depending upon the type of condition, the severity and the factors that have caused it. Given below are some of the most common symptoms of pericarditis -

• Accelerated heartbeat
• Shortness of breath
• Coughing
• Fatigue
• Swelling in the legs and abdomen
• Pooling of the fluid between the pleura
• Fever

If you experience these symptoms for more than 6 months, you are suffering from chronic pericarditis. This type of pericarditis rarely causes pain in the chest. Therefore, you need to seek emergency medical attention if you develop chest pain. Your doctor may ask you to undergo a few tests which include, chest x-rays, MRI, CT scan of the chest, echocardiogram and pericardial biopsy for an accurate diagnosis.

Treatment

The treatment for chronic pericarditis depends upon its severity as well as the causes. Given below are some of the options that are usually considered -

• Medication to reduce the swelling and inflammation, which usually includes over the counter painkillers, corticosteroids, NSAIDs and antibiotics
• Pericardiectomy, a surgery in which doctors remove the entire pericardium because it has turned rigid
• Pericardiocentesis, a procedure where a catheter or sterile needle is used to get rid of the excessive fluid from the pericardial cavity.

For more severe cases of chronic pericarditis, hospitalization may be required. People suffering from this condition are often asked to restrict their intake of salt and get a lot of rest.

Prognosis

The outcome of chronic pericarditis treatment may differ from one patient to the other; while some may get complete relief from the symptoms, others may see little or no difference. Some of the factors that have a negative impact on chronic pericarditis treatment include -

• Organ failure
• Ascites
• Coronary heart disease that has not been treated
• Myocardial fibrosis

It is absolutely essential to have chronic pericarditis closely monitored and treated by a doctor at all times.

References

• Cohen S, et al. Pericarditis. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011
• Pericarditis. The Merck Manuals: The Merck Manual for Healthcare Professionals

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