Recurrent pericarditis (NORD)
Definitions & Key takeaways
Recurrent pericarditis is a condition characterized by multiple episodes of inflammation of the pericardium, the sac that surrounds the heart. Recurrent pericarditis is often caused by autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis; metabolic disorders such as kidney failure inflammatory diseases like familial Mediterranean fever; but anything that can cause pericarditis can also cause recurrent pericarditis.
Symptoms include stabbing chest pain radiating to the neck or the back, shortness of breath, extreme tiredness, tachycardia, and irregular heartbeats. A diagnosis is typically made based on a clinical examination, an electrocardiogram, and blood tests, and it is commonly treated with anti-inflammatory medications to reduce inflammation and pain, and colchicine to prevent recurrences.
Recurrent pericarditis is a disease characterized by recurring episodes of swelling or inflammation of the fluid filled sac surrounding the heart, the pericardium.
Pericarditis is considered recurrent when an episode occurs at least four to six weeks after the end of a previous episode.
Each episode may last days to weeks and be followed by a period of time with no symptoms between episodes.The main symptom of a pericarditis episode is a sharp chest pain that increases when taking deep breaths and lying down.
Pain may decrease when bending forward and may spread to the neck, upper back, or shoulders. Other symptoms include shortness of breath, fever, tiredness, not feeling well, and a feeling that the heart is beating too hard or fast.
Symptoms of a recurrent pericarditis episode are usually similar to, but less severe than, the first episode. If the pericarditis becomes severe, blood flow throughout the body may decrease.
This decreased blood flow may make symptoms more intense, and may cause new symptoms such as dizziness, confusion, nausea, clammy moist skin, feet swelling, and loss of consciousness.Anything that can cause pericarditis can also cause recurrent pericarditis.
Most often this includes autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, but may also be caused by metabolic disorders such as kidney failure, and rare inflammatory diseases like familial Mediterranean fever.
Recurrent pericarditis can also be caused by pericardial infections from viruses, drugs that target the pericardium, cancer, heart attacks and cardiac surgery.All of these causes result in damage to pericardial tissue.
In response to the pericardial injury, the body’s immune system begins to repair the tissue, causing swelling and inflammation in the area.
This inflammation may expand to surround the lungs leading to chest pain and difficulty breathing. The inflammation can also cause blood vessels around the heart to become leaky, allowing fluid to pool in the space between the heart and the pericardium.
If inflammation is prolonged, scar tissue may begin to form around the pericardium. This scar tissue can impair heart contraction and decrease elasticity of the pericardium.
Although rare, this decrease in heart contraction and elasticity is serious. Blood pressure may build up in veins entering the heart and pressure may lower from arteries leaving the heart.
This results in veins in the neck becoming visibly larger. It also leads to fluid build-up in the lungs and feet.
Diagnosis of recurrent pericarditis starts with a review of symptoms, medical history, and physical evaluation. During the examination, a clinician will often listen for a characteristic scratching heart sound caused by the inflamed pericardium rubbing on the heart.
If pericarditis is suspected, diagnostic tests may be performed starting with an electrocardiogram, which measures electrical activity of the heart.
Blood tests may show increased white blood cells, and other inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate.
Diagnostic imaging like magnetic resonance imaging can also be used to confirm pericarditis. Additional tests may be conducted depending on the cause of pericarditis such as antinuclear antibody blood testing for systemic lupus erythematosus.The first treatment is a combination of colchicine and a non-steroidal anti-inflammatory drug, or NSAID, such as aspirin or ibuprofen given until symptoms resolve.
Colchicine and NSAIDs reduce inflammation throughout the body by blocking production of inflammatory molecules.If symptoms don’t resolve, NSAIDs may be replaced with prednisone, a powerful anti-inflammatory steroid.
Individuals with continued symptoms may benefit from a combination of all three: colchicine, an NSAID, and prednisone. Additionally, treatment may include treating the underlying cause such as antibiotics for bacterial infections.
Rilonacept is a medication that blocks the immune system and inflammatory effects of the protein, interleukin-1. If medication isn’t enough to resolve the pericarditis, surgical removal of the pericardium may be considered.Alright, so here’s a quick recap.
Recurrent pericarditis is episodes of inflammation of the pericardium that reoccur. Symptoms include a stabbing chest pain, shortness of breath, and extreme tiredness.
Most often, recurrent pericarditis is caused by an underlying disease in which the body’s immune system fights its own cells.
A diagnosis is typically made based on a clinical examination, an electrocardiogram, and blood tests. Recurrent pericarditis is usually treated with colchicine and an NSAID until the pericarditis goes away.
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