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PERICARDITIS - MYOCARDITIS

What is Pericarditis ?

Pericarditis is inflammation or infection of the outside lining of the heart, called the pericardium. Myocarditis is inflammation or infection of the muscle of the heart. Because the pericardium covers the heart muscle, myocarditis may also occur if there is pericarditis. The commonest symptom of pericarditis is chest pain. The pain is usually sharp, in the front of the chest. It may spread to the back, the shoulders, or the arms and may be aggravated by coughing or swallowing. There may be a fever with both conditions. Pain is less common with myocarditis, which is more likely to affect the function of the heart, causing heart failure. This may produce breathlessness or swelling of the feet and ankles. With pericarditis, fluid may sometimes accumulate around the heart. This is called a pericardial effusion although an effusion can be due to other conditions as well. If there is enough fluid it compresses the heart and impairs its pumping function; this is called tamponade.

Why does Pericarditis occur ?

There are many causes of pericarditis. The commonest is infection with a virus, but it can also be due to infection with bacteria or to rheumatic fever or rheumatoid arthritis (one of the so called auto-immune diseases). There are different sorts of viruses, most of which get into the body through the nose or mouth. One of the commonest is called coxsackie but even chicken pox or flu viruses can cause it occasionally The bacterium of tuberculosis may cause a particular form of pericarditis many years later, called constrictive pericarditis. It may also happen after a heart attack (myocardial infarction), after heart surgery and after chest injury. Very rarely, cancer can invade from outside the heart to cause pericarditis. Myocarditis is also usually caused by a virus, although it can occasionally be due to an auto-immune disease such as systemic lupus, erythematosus (SLE).

Treatment Involved for Pericarditis

DIAGNOSIS In most cases of pericarditis a virus is probably the cause but attempts to find it are usually unsuccessful. It is even more difficult to find the virus which causes myocarditis.This is not very important because it does not make any difference to the treatment. Viruses cannot be treated with antibiotics. It is more important to be sure that there is not another cause which may demand specific treatment. The auto-immune diseases are diagnosed with special blood tests. Electrocardiograms (ECGs) usually help to diagnose a myocardial infarct. Chest x-rays often repeated over a period of time are helpful: they show the changes in the size of the heart. Echocardiography is also valuable. This technique uses ultrasound to picture the heart on a television screen. A microphone-like instrument (transducer) is placed on the chest. It transmits ultrasound which is reflected from the heart back to the transducer, where the sound waves are converted into electrical impulses to produce the TV picture. Rarely, cardiac catheterization may help to diagnose myocarditis. For this, a fine tube (catheter) is inserted through an artery in the groin or arm and passed through the arteries into the heart. Pressures inside the heart can be measured and x-ray dye injected whilst recording moving pictures. At the same time, a small piece of heart muscle can be taken with a special cardiac catheter. It then can be examined by pathologists under the microscope.

TREATMENT Treatment of the pain, which can be quite severe, is usually all that is required for pericarditis. Even severe pain, however, does not mean that the condition is serious. Pericarditis due to auto-immune disease may need special anti-inflammatory drugs. These include drugs called non-steriodal anti-inflammatory drugs (NSAID) as well as steroids. Occasionally they are also needed for pericarditis after a myocardial infarct or heart surgery. Infections, other than viral, may need antibiotics. This is especially true for tuberculosis. Constrictive pericarditis, when the pericardium becomes thick and fibrous, preventing the heart from pumping, needs surgical treatment. The pericardium has to be removed to relieve the constriction. Tamponade also requires special treatment. The fluid must be removed with a needle and syringe passed through the chest wall. Myocarditis usually requires little treatment unless the heart's pumping function is affected. If this is the case, "heart failure" occurs. It causes breathlessness and swelling of the feet and ankles. Special treatment for heart failure is then needed. The heart's function often returns to normal or it may be permanently damaged leading to a condition called dilated cardiomyopathy in which the heart becomes enlarged.

During Treatment for Pericarditis

In pericarditis, look out for symptoms which suggest that a pericardial effusion is developing. These symptoms are like those of heart failure; in particular there is swelling of feet and ankles and breathlessness. Sometimes the swelling involves the abdomen (stomach) also. With auto-immune diseases there may be other symptoms including rashes and joint pains. Myocarditis may also produce the symptoms of heart failure.

After Treatment for Pericarditis

Some types of pericarditis may come back, particularly after a myocardial infarct or heart surgery. More treatment may be needed. A pericardial effusion and tamponade can also occasionally recur. The features of constrictive pericarditis may take many years to appear. Other symptoms of auto-immune disease also may not appear until much later. After an episode of myocarditis, be on the lookout for the, symptoms of heart failure and seek help from your doctor. This may indicate that it has developed into a cardiomyopathy.

If Pericarditis is Left Untreated

In pericarditis, treatment is mainly for pain. No other treatment is needed. Unless there is underlying disease, the long term outlook is excellent. The same is usually true for myocarditis, on the whole. However, myocarditis from some causes, including auto-immune disease, would certainly get worse without appropriate treatment.