Chronic pericarditis
Chronic pericarditis is defined as pericarditis that persists for more than three months.
There are two main types of chronic pericarditis:
- chronic effusive pericarditis – when an excess amount of fluid gathers in the space inside the pericardium
- chronic constrictive pericarditis – where the tissue of the pericardium becomes hardened through scarring
Chronic effusive pericarditis
It is hard to estimate exactly how widespread chronic effusive pericarditis is as most cases do not cause any noticeable symptoms. One study estimated that 1 in 20 older adults have some degree of effusion (build-up of fluid) inside their pericardium.
In cases where symptoms are present, they may include:
- chest pain
- light-headedness
- cough
- shortness of breath
- hiccups
Possible causes of chronic effusive pericarditis include:
- infections, such as hepatitis or tuberculosis
- cancers that spread from other parts of the body to the pericardium
- damage or injury that occurs during surgery
However, in many cases no obvious cause can found.
Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) are the first treatment to try.
If medication fails to be effective, surgery may be recommended. Chronic effusive pericarditis can be treated with a surgical technique called a pericardiocentesis.
During a pericardiocentesis, a thin plastic tube known as a catheter will be passed through the chest and guided into the pericardium. Imaging technology, such as an echocardiogram, may be used to guide the catheter with accuracy. The catheter then drains away the excess fluid. A local anaesthetic is is used to numb the skin of your chest so you will not feel any pain during the procedure.
Chronic constructive pericarditis
It is estimated that 1 in 10 people with a history of acute pericarditis will go on to develop chronic constructive pericarditis.
The most common symptom of chronic constructive pericarditis is shortness of breath.
Other symptoms include:
- fatigue
- abdominal pain and swelling
- nausea
- vomiting
Possible causes of chronic constructive pericarditis include:
- infections – such as tuberculosis
- complications of radiotherapy
- damage or injury that occurs during surgery
However, in most cases no obvious cause can be found.
Unlike the acute form of pericarditis, chronic constructive pericarditis tends not to respond well to medication and usually the only realistic option for a complete cure is to surgically remove the pericardium (pericardiectomy).
However, this type of surgery carries a 1 in 20 risk of causing death, so surgery would only usually be recommended if your symptoms were having a significant adverse effect on your quality of life.
Cardiac tamponade
In a small number of cases, inflammation of the pericardium can lead to a large build-up of fluid inside the pericardium. The extra fluid puts the heart under pressure, which makes it unable to pump blood around the body as effectively as normal. This is known as cardiac tamponade.
Cardiac tamponade is a potential complication in all cases of pericarditis, but it is more common in cases where pericarditis has been caused by tuberculosis or cancer.
If the heart cannot pump blood at the normal level, blood pressure can drop rapidly and cause:
- light-headedness
- blurred vision
- palpitations
- confusion
- nausea
- general weakness
- a temporary loss of consciousness
Cardiac tamponade is life threatening and requires emergency treatment. If you have a history of pericarditis and develop the symptoms listed above, call 999 and ask for an ambulance.
Cardiac tamponade is usually treated with a pericardiocentesis, as mentioned above.
