Pericarditis - causes, signs and therapy

Pericarditis - causes, signs and therapy

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The medical term "pericarditis" or Pericarditis denotes an inflammatory disease of the pericardium, which causes severe chest pain, which is typically aggravated when lying down or coughing. In most cases, viruses are the trigger, which can cause pericarditis, for example, after an infection of the gastrointestinal tract or the respiratory tract. A number of non-infectious causes are possible, such as hypothyroidism and autoimmune diseases such as lupus erythematosus or rheumatism. Acute, viral cardiac inflammation usually takes a good course and heals within one to three weeks. In rare cases, however, complications such as a pericardial effusion or scarring can occur. Accordingly, complaints such as chest pricking and shortness of breath should always be immediately clarified by a doctor and treated accordingly.

Definition: what is pericarditis?

The so-called “pericardium” (medical: pericardium) is an envelope made of tight connective tissue that almost completely surrounds the heart. The bag consists of an outer layer (Pericardium fibrosum) and the "Pericardium serosum", which covers the inner surface and is also referred to as a "serous" pericardium. This is subdivided into the so-called "parietal leaf" (Lamina parietalis), which is firmly attached to the outer layer, and the "visceral leaf" (Lamina visceralis), which is also known under the term "epicardium" or "epicardium" . This lies directly against the heart and thereby covers the outer surface of the heart and the roots of the large blood vessels.

Between the two leaves is the pericardial cavity, in which there is usually about 10-20 ml of liquid (liquor pericardii). This serves as a “sliding film”, which reduces the friction between the epicardium and the pericardium and accordingly enables a low-friction heart function. In addition, the sheath fixes the heart in the correct position, which at the same time important structures in the chest area such as the breastbone or large blood vessels are always in the correct position to the heart. There are also other central functions such as the separation of the heart from other organs and protection against overextension during physical exertion.

If there is an inflammatory disease of the pericardium, the term “pericarditis” is used medically, whereby a distinction is made between an acute, an acute recurring (“recurrent”) and a chronic form. Infectious and non-infectious inflammations are also differentiated. While the former is caused by infection with viruses, bacteria and fungi, for non-infectious pericarditis e.g. Autoimmune diseases such as rheumatism, heart failure or certain medications are considered triggers.

Pericarditis causes

In addition to some unknown triggers, the following causes can be considered for acute pericarditis:

  • Heart attack,
  • Virus or bacterial infections,
  • After-effects of heart surgery (postpericardiotomy syndrome),
  • Lupus disease (lupus erythematosus),
  • Rheumatoid arthritis,
  • Kidney failure,
  • Chest injuries,
  • Rheumatic fever,
  • Leukemia,
  • Breast cancer,
  • Lung cancer,
  • After-effects of radiation therapy,
  • Side effects of medication (e.g. warfarin, heparin, penicillin, procainamide or phenytoin).

There are many possible triggers for pericarditis, with around half of the diagnosed cases remaining without a proven cause ("idiopathic"). If the reason has been identified, most of the patients are infected, with coxsackie, adeno and echoviruses playing an important role. In addition to this, it can in rare cases also be caused by pathogens such as Epstein-Barr or hepatitis viruses in immunocompromised people (e.g. through HIV). In addition, bacteria can be considered as triggers because they can get from a local inflammation via the bloodstream to other areas of the body and thus also into the pericardium. This is possible e.g. in connection with pneumonia or tonsillitis, after a tooth has been surgically removed (extraction) or in the case of tuberculosis, in which the causative mycobacteria spread through the blood in the body.

Tuberculous pericarditis is now rare in western countries, e.g. with immunocompromised people or immigrants from Africa or Asia. In addition to the typical heart symptoms, symptoms such as excessive sweating at night and weight loss often occur here. In addition, other body regions such as the brain is affected (tubercular meningitis), which can lead to further complaints such as headache, loss of consciousness, seizures or fever.

In addition, inflammation of the pericardium can be caused by a number of non-infectious causes. These include metabolic diseases such as gout or an underactive thyroid, as well as various types of cancer such as leukemia, lymphoma, lung or breast cancer, in which deposits of a malignant tumor (metastases) form in the pericardium.

Kidney disease is also possible because certain urinary substances are not excreted in the urine, but remain in the body (uremic pericarditis) and can cause inflammation here. Likewise, pericarditis can occur a few days after operations or injuries to the heart and after a heart attack in the damaged areas. A special case is the so-called "Dressler syndrome", which only occurs weeks or even months after an infarction and is characterized by symptoms such as reduced performance, fever and an increase in white blood cells (leukocytes) in the blood.

The background can also be a so-called "autoimmune disease", in which the body's immune system (immune system) incorrectly creates body structures due to an excessive reaction, e.g. Attacks cells or tissues. As a result, there are severe inflammatory reactions, which, if left untreated, can lead to the destruction of the affected organ and even death in an emergency. In addition to organs such as Thyroid gland (Graves' disease) or skin (Pemphigus vulgaris) can also affect the pericardium, which can become inflamed as a result of certain autoimmune diseases and lead to pericarditis. For example, here Inflammatory-rheumatic diseases such as lupus erythematosus, connective tissue hardening, scleroderma or rheumatoid arthritis. Granulomatosis with polyangiitis (GPA) can also be the cause, a systemic disease of the vascular system in which the immune system is directed against components of certain white blood cells. Certain medications are responsible for the symptoms, and in rare cases it is possible that even months to years after radiation, inflammation of the pericardium occurs (radiation pericarditis).

Pericarditis symptoms

The symptoms often resemble the symptoms of chest tightness (angina pectoris), whereby the specific expression depends on the cause and the course of the disease. The acute form of pericarditis is mainly characterized by severe, sharp, sharp chest pain, which, in contrast to angina pectoris, is mostly movement-dependent and e.g. Strengthen when lying down, by coughing or breathing deeply. If, on the other hand, those affected sit upright and bend their upper bodies forward, there is usually a significant improvement.

The pain can radiate up to the neck and shoulder area, as can upper abdominal pain, whereby the left side is more affected. There are also other non-specific symptoms such as Fever, reduced resilience, fatigue and exhaustion as well as heavy sweating, which mostly occur in connection with the respective underlying disease.

Chronic pericarditis, on the other hand, usually causes hardly or only slightly perceptible symptoms that are often rather non-specific, such as a reduced resilience and exhaustion. In some cases, however, a build-up of tissue fluid (“pericardial effusion”) develops between the two layers of the pericardium, which limits the pumping movement of the heart and reduces the cardiac output accordingly. As a result, there are typical symptoms of heart failure, such as Shortness of breath, circulatory problems, congested neck veins or an enlargement of the liver, thick legs (leg edema) or water retention in the abdomen (ascites) are also possible.

If the pericardial effusion is very pronounced, this can lead to a so-called "pericardial tamponade", a dangerous complication that requires immediate medical emergency care. Here the large effusion leads to a slow failure of the heart functions, which can lead to a drop in blood pressure, rapid heartbeat, circulatory problems, shortness of breath and cardiogenic shock. Another, rarer consequence of the disease is constrictive pericarditis (“armored heart”), a thickening and calcification of the pericardium due to frequently recurring inflammation, which makes normal expansion of the heart impossible. Typically, symptoms of heart failure such as e.g. Poor performance, shortness of breath, swollen legs, blue lips and protruding neck veins.

Therapy for pericarditis

In many cases, treatment is inpatient, with the focus being on the therapy of the causative disease - as far as is known. Accordingly, e.g. In the case of viral inflammation, painkillers with anti-inflammatory effects (non-steroidal anti-inflammatory drugs, in short: NSAIDs), such as ibuprofen or diclofenac, are used in conjunction with gastric protective agents. If bacteria have been detected, the doctor usually prescribes antibiotics, but in the rarer case of inflammation due to a heart attack, acetylsalicylic acid (ASA) is administered.

If the anti-inflammatory therapy does not work, the patients usually receive colchicine or less often cortisone. If the pericarditis is based on an autoimmune disease, drugs to suppress the immune system (glucocorticoids) are used. In the case of complications such as a cardiac tamponade, however, a puncture of the pericardial effusion is necessary, the same applies if there are major symptomatic effusions or if there is suspicion of tubercular or purulent pericarditis.

In parallel with drug treatment, those affected by pericardial inflammation should definitely keep their bed in order not to disturb the healing process and to avoid complications.

Naturopathy for pericarditis

In addition to conventional medical treatment, naturopathy can help alleviate the symptoms of inflammation of the pericardium. However, a discussion with the doctor treating you should always take place beforehand in order to avoid health risks and side effects or possible interactions with other medications.

Homeopathy for pericarditis

Even if the effectiveness of homeopathy is controversial from a scientific point of view, many people trust homeopathic remedies. From the field, for example, the agent potassium carbonicum comes into question, the potassium salt of carbonic acid, which is often also referred to as “potash”. The fields of application for this remedy are versatile, so that it is not only used for inflammatory heart diseases, but e.g. is also used for kidney problems, respiratory problems such as asthma or hoarseness or complaints of the digestive system. In addition, Asclepias tuberosa can be used for severe stinging chest pain, especially if it is exacerbated by breathing, movement, cold and wet, and less when bending forward.

Kalmia (mountain laurel) is also used less often, in which case it is typical of sharp pains in the heart region that radiate to the left arm. In addition, Kalmia patients typically experience the feeling of a constricted, tight chest, permanent racing heart and a strong heartbeat.

Schüssler salts can be a valuable support in the treatment. The salts potassium phosphoricum (no. 5) and potassium sulfuricum (no. 6) play an important role here, as well as potassium chloratum (no. 4) has proven its worth especially with progressive inflammation. Calcium Phosphoricum (No. 2) can also have a positive effect on the healing process. In addition, Calcium Fluoratum (No. 1) and Silicea (No. 11) are particularly suitable for naturally supporting the body during the regeneration phase. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese


  • German Heart Center Munich: diseases of the pericardium (retrieval: 29.08.2019), dhm.mhn.de
  • Merck and Co., Inc.,: Acute Pericarditis (accessed: Aug 29, 2019), msdmanuals.com
  • American Heart Association, Inc .: What is Pericarditis? (Accessed: 29.08.2019), heart.org
  • Mayo Clinic: Pericarditis (accessed: August 29, 2019), mayoclinic.org
  • Cleveland Clinic: Pericarditis (accessed: August 29, 2019), my.clevelandclinic.org

ICD-Codes for this illness: I09, I30-I32ICD-Codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Recurrent Pericarditis Treatment (August 2022).