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Manhattan Cardiology
What is Pericarditis? | Dr. Ami Beniaminovitz

“Pericarditis is inflammation of the pericardial sac, which is the fibroelastic sac that surrounds the heart.

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Pericarditis is an inflammation of the sac around the heart. The heart sits in a sac that acts as a skeleton and a scaffolding for the heart, and sometimes it can get inflamed and you’ll feel chest pain. Pericarditis has many causes, both from drugs that can cause it, a lot of tuberculosis drugs can cause it. Usually though, pericarditis is caused after a viral infection, and the reason it’s getting so much press lately is because it can be a sequelae of, or a consequence of having COVID. Other things, sadly, that can cause it are malignancies, but for the most part you’ll see it quite frequently in clinic secondary to some infection. Other states that can cause pericarditis are chronic inflammatory states, any autoimmune disease is very notorious for it, lupus, rheumatoid arthritis. Symptoms are chest pain, but it’s a very specific chest pain where cardiac chest pain ebbs and flows or comes and goes.

Pericarditis is pretty constant and it’s an odd chest pain because it generally gets better when you lean forward. The reason for that is because you’re creating a little bit more space between your chest and the pericardium or that sac in your heart, and it gets worse when you lean back or lay down and it’s a chest pain that actually doesn’t really go away, and it just is constantly there and very painful. The thing with pericarditis, it can often mimic a heart attack, so it’s very important for people who have or suspect pericarditis to go see a cardiologist or even go to the hospital to make sure that they’re actually not having a heart attack. If you see a person who’s having chest pain but is not having a heart attack and is presenting classically for pericarditis, you can make the diagnosis that way.

Pericarditis can become life threatening if it gets to what’s called myopericarditis, and if the pericardium has been so inflamed to the point where it gets a little stiff and the heart can’t actually expand, and if that elasticity is actually compromised because of chronic pericarditis or stiffening of the pericardium, that can affect the heart’s ability to pump effectively, so then it can be a deadly manifestation of pericarditis. Thankfully, most times pericarditis is treated earlier, that you don’t get into what’s called that chronic state of pericarditis and you don’t get that hard pericardium, but it is something that should actually be always looked for. So pericarditis is typically treated by a short course of what’s called NSAID, non-steroid anti-inflammatory drugs. We know them more colloquially as Advil or Aleeve, even aspirin. Mostly we use ibuprofen and we use it a higher doses than normal.

If that doesn’t work after about two weeks, we may use something called Colchicine as well, which is another anti-inflammatory immunomodulator. If people come into the state where they have chronic pericarditis, there may be other things, there are new developments now with monoclonal antibodies to help it out, as well as something called pericardial stripping where they actually do surgery to actually remove it in the most extreme cases. It’s something that people should really come and see a doctor for. There are treatments for it, and there are ways to help people feel better. I don’t think it’s acceptable for people to just live in pain. They should really seek treatment for it because it is something that we can actually do a lot for.”