Pericarditis is an inflammation of the pericardium. It is a pathological condition that may successfully mimic a heart attack. Some cases of pericarditis are not serious, but others may cause fatal complications. First, it is necessary to know some information about the pericardium itself. Pericardium is basically a bag, in which the heart is stored. Pericardium protects the heart and allows its periodic contractions and dilations.


There are numerous cases of pericarditis, which can be divided into infectious and non-infectious. Infectious pericarditis can be caused by certain viruses, bacteria and even some fungi. Non-infectious pericarditis can occur in many autoimmune diseases, malignant diseases, underactive thyroid gland and accumulation of waste products in the body in chronic renal failure (technically uremia).


There are two basic types of pericarditis – dry and wet. Both are accompanied by elevated body temperature. Dry pericarditis is usually the first and later it transforms into the wet form. In dry pericarditis, the pericardium is inflamed and the heart rubs the irritated tissue during its contractions. This results in acute chest pain that may be easily mistaken for a heart attack. Dry pericarditis can turn into wet pericarditis when the inflamed cells start to produce fluid that accumulates in the pericardium. This situation is accompanied with significant relief and disappearance of the chest pain. When the condition is uncomplicated, the fluid is gradually absorbed and the disease heals. However, when the volume of produced fluid is too big, it may compress the heart and disrupt its pumping function. This situation is known as the cardiac tamponade. Cardiac tamponade may cause acute heart failure and rapid death.


The diagnosis of dry pericarditis and especially its differentiation from a heart attack may be difficult. Chest pain is present in both conditions and so are certain ECG changes and elevation of cardiac markers. Therefore, even an experienced doctor may very easily confuse these two diseases and may send the patient with pericarditis to coronary angiography, which has negative result.


Note: Theoretically, when listening with a stethoscope put on a chest of patient with dry pericarditis, we may hear a rubbing sound. This sound occurs due to friction between the heart wall and the inflamed pericardium.


Wet pericarditis can be suspected even from a chest X-ray as the heart shadow is dilated due to the fluid-filled pericardium. The best examination method is the echocardiography, which can accurately determine the amount of pericardial fluid, the heart pumping ability and the risk of cardiac tamponade.


When we confirm the presence of a pericarditis of unknown origin, we should also look for any signs of tumors or autoimmune diseases (at least by basic examinations).


Dry pericarditis is treated by bed rest and administration of anti-inflammatory drugs. Wet pericarditis is treated substantially identically, but the patient should be regularly checked to rule out excessive accumulation of fluid, which increases the risk of cardiac tamponade. When the cardiac tamponade is imminent or even ongoing, the situation must be solved by acute drainage. This intervention means puncture of the pericardial sac with a needle and aspiration of the fluid.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources