Pericardial Disorders

The pericardium is a thin sac around the heart that holds it in place and helps it work smoothly. Problems with the pericardium cause a group of conditions that are uncommon but treatable when caught.

Main types

• Pericarditis — inflammation of the sac. Causes sharp chest pain that's often worse lying flat and better sitting forward.
• Pericardial effusion — fluid build-up around the heart.
• Cardiac tamponade — a dangerous build-up that presses on the heart and stops it from filling properly. Medical emergency.
• Constrictive pericarditis — the sac scars and stiffens, squeezing the heart over time.

Common causes

• Viral infection — the commonest cause worldwide.
• Tuberculosis — a major cause in India and still important to actively consider in any pericardial disease.
• After a heart attack or heart surgery.
• Autoimmune disease (lupus, rheumatoid arthritis).
• Kidney failure.
• Cancer spreading to the pericardium.

Symptoms

• Sharp chest pain, often worse with deep breathing or lying flat, better when sitting forward.
• Fever, tiredness (especially with infection cause).
• Breathlessness.
• Swelling of legs or belly (in chronic forms).

Red flags — dial 112

• Severe shortness of breath.
• Fainting or near-fainting.
• Rapidly dropping blood pressure.
• These may indicate tamponade and need urgent drainage.

Diagnosis and treatment

• ECG, ECHO (echocardiogram) and blood tests diagnose most pericardial disease.
• Viral pericarditis often settles with anti-inflammatory medicines and rest.
• TB pericarditis needs a full course of anti-TB treatment — highly effective when completed properly.
• Tamponade is drained with a needle (pericardiocentesis).
• Constrictive pericarditis may need surgery to remove the thickened sac.