Pericarditis - causes, signs and therapy

The medical term "pericarditis" refers to an inflammatory disease of the pericardium, which results in severe chest pain, which typically increases when lying or coughing. In most cases, viruses are the trigger that can cause pericarditis, for example after an infection of the gastrointestinal tract or the respiratory tract. There are a number of non-infectious causes such as hypothyroidism and autoimmune diseases such as lupus erythematosus or rheumatism. Acute, virally induced pericarditis usually progresses well and heals within one to three weeks. In more rare cases, however, complications such as pericardial effusion or scarring may occur. Accordingly, complaints such as breast piercing and shortness of breath should always be clarified immediately by a doctor and treated accordingly.

contents

• Definition: What is pericarditis??
• causes
• Symptoms of inflammation of the pericardium
• Therapy for pericarditis
• Naturopathy with pericarditis

Definition: What is pericarditis??

The so-called "pericardium" (medical: pericardium) is a shell of tight connective tissue that almost completely encloses the heart. The pouch consists of an outer layer (Pericardium fibrosum) and the "Pericardium serosum" which covers the inner surface and is also referred to as the "serous" pericardium. It is subdivided into the so-called "parietal leaf" (lamina parietalis), which is firmly connected to the outer layer, and the "visceral leaf" (lamina visceralis), which is also known by the term "epicardium" or "epicardium" , This is directly adjacent to the heart and thereby covers the outer surface of the heart as well as the roots of the large blood vessels.

An ECG provides information about the heart rhythm. (Image: Kzenon - fotolia)

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

If there is an inflammatory disease of the pericardium, it is medically referred to as "pericarditis", whereby a distinction between an acute, an acutely recurring ("recurrent") and a chronic form. In addition, infectious are distinguished from non-infectious inflammations. 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 as a trigger into consideration.

causes

There are many possible triggers for pericarditis, with over half of the diagnosed cases remaining without demonstrable cause ("idiopathic"). If the reason could be identified, most of the patients are infected, with coxsackie, adeno and echoviruses playing an important role. In addition, in immunocompromised individuals (for example, by HIV), in rare cases, it can also be caused by pathogens such as Epstein-Barr or hepatitis viruses. In addition, bacteria come as a trigger into consideration, as they can get from a local inflammation through the bloodstream in other areas of the body and thus in the pericardium. This is possible, e.g. in connection with pneumonia or tonsillitis, after surgical removal of a tooth (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. in immunocompromised or immigrant from Africa or Asia people. Here, in addition to the typical heart symptoms, symptoms such as excessive sweating at night and weight loss often occur. In addition, other body regions such as e.g. The brain can be affected (tuberculous meningitis), which can lead to other complaints such as headache, impaired consciousness, seizures or fever.

In addition, inflammation of the pericardium may be caused by a variety of non-infectious causes. These include metabolic diseases such as gout or hypothyroidism as well as various cancers such as leukemia, lymphoma, lung or breast cancer, which form colonies of a malignant tumor (metastases) in the pericardium.

It is also possible to have kidney disease since certain urinary substances are not excreted in the urine but remain in the body (uremic pericarditis) and can trigger inflammation here. Likewise, a few days after surgery or injury to the heart and after a heart attack in the damaged areas may lead to pericarditis. A special case is the so-called "Dressler syndrome", which occurs weeks or even months after an infarction and is characterized by symptoms such as decreased performance, fever and an increase in white blood cells (leukocytes) in the blood.

Background may also be a so-called "autoimmune disease" in which the body's immune system (immune system) due to an excessive reaction falsely endogenous structures such. Cells or tissue attacks. As a result, severe inflammatory reactions occur, which, if left untreated, can destroy the affected organ and even death in an emergency. Besides organs such as e.g. Thyroid (Graves' disease) or skin (pemphigus vulgaris) may also affect the pericardium, which can become inflamed in the wake of certain autoimmune diseases and can lead to pericarditis. Eligible here are e.g. Diseases of the inflammatory rheumatic type such as lupus erythematosus, connective tissue hardening scleroderma or rheumatoid arthritis. Likewise, granulomatosis with polyangiitis (GPA) may 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 discomfort, as it is also possible in rare cases that even months to years after an irradiation inflammation of the pericardium occurs (radiation pericarditis).

Symptoms of inflammation of the pericardium

The symptoms are often similar to the complaints of a chest tightness (angina pectoris), whereby the specific expression of the cause and the course of the disease is dependent. Characteristic of the acute form of pericarditis are, in particular, strong, sharply stabbing chest pains, which, in contrast to angina pectoris, are usually motion-dependent, and which are e.g. lying down, intensified by coughing or deep breathing. On the other hand, if the affected person sits upright and flexes his upper body forward, he usually undergoes a significant improvement.

The pain can radiate up to the neck and shoulder area, as well as upper abdominal pain may occur, but rather the left side is affected. In addition, there are other nonspecific symptoms such as Fever, decreased resilience, fatigue and exhaustion, and heavy sweating, which usually occur in connection with the underlying disease.

Chronic pericarditis, on the other hand, usually causes little or only mildly perceptible symptoms, which are often rather unspecific, such as a reduced resilience and fatigue. In some cases, however, an accumulation of tissue fluid ("pericardial effusion") subsequently develops between the two layers of the pericardium, restricting the pumping motion of the heart and correspondingly reducing cardiac output. As a result, typical complaints of cardiac insufficiency, such as Shortness of breath, circulatory problems, jammed neck veins or enlargement of the liver, are also possible thick legs (leg edema) or water retention in the abdominal area (ascites).

In a cardiac ultrasound, for example, the doctor can detect wall thickening of the heart. (Image: Alexander Raths - fotolia)

If the pericardial effusion is very severe, this can lead to a so-called "pericardial tamponade", a dangerous complication that requires immediate emergency medical care. Here, the large effusion leads to a slow failure of the heart functions, which can lead to hypotension, palpitations, circulatory problems, respiratory distress and a cardiogenic shock. Another, more rare consequence of the disease is the pericarditis constrictiva ("armor heart"), a thickening and calcification of the pericardium due to frequent recurrent inflammation, which makes a normal expansion of the heart impossible. Here, too, symptoms of cardiac insufficiency, such as, for example, typically occur. Low performance, shortness of breath, swollen legs, blue lips and prominent jugular veins.

Therapy for pericarditis

The treatment is in many cases inpatient, especially the therapy of the causative disease - so far known - is the focus. Accordingly, e.g. in viral inflammation usually analgesics with anti-inflammatory effect (non-steroidal anti-inflammatory drugs, short: NSAIDs) such as ibuprofen or diclofenac used in conjunction with gastric protective agents. If bacteria could be detected, the doctor usually prescribes antibiotics, in the rarer case of inflammation as a result of a heart attack, however, acetylsalicylic acid (ASA) is administered.

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

Patients suffering from pericarditis should be bed rested at all times in order to avoid disturbing the healing process and to avoid complications.

Naturopathy with pericarditis

Naturopathy can often help to alleviate the symptoms of inflammation of the pericardial sac. Here, however, should always take place in advance with the attending physician to prevent health risks and side effects or possible interactions with other drugs.

From the field of homeopathy here comes, for example, the agent potassium carbonicum in question, the potassium salt of carbon dioxide, which is often referred to as "potash". The uses are versatile in this remedy, so it is not only in inflammatory heart disease, but, for. Also used in kidney problems, respiratory problems such as asthma or hoarseness or discomfort of the digestive system. In addition, Asclepias tuberosa may be considered for severe stabbing chest pain, especially when it is increased by breathing, movement, cold and wetness, and less when bending forward.

Kalmia (mountain laurel) is also rarely used, in which case there are typically sharp pains in the heart region that radiate to the left arm. In addition, Kalmia patients typically experience a tight, narrow chest, permanent palpitations, and a pronounced heartbeat.

Schüssler salts can be a valuable support in the treatment. Potassium Phosphoricum (No. 5) and Potassium Sulfuricum (No. 6.) play an important role here, and potassium chloratum (No. 4) has proved its worth, especially with advancing inflammations. Also, Calcium Phosphoricum (# 2) can positively affect the healing process, and in particular, the Calcium Fluoratum (# 1) and Silicea (# 11) are well-suited to naturally support the body in the regeneration phase. (No)

Picture credits above: Dieter Schütz