The pericardium is the structure that covers and protects the heart and consists of two membranes separated by a thin layer of liquid.

If the pericardium undergoes inflammation one speaks of pericarditis. In its presence, the membranes become inflamed and there may be an increase in fluid, which in some cases can compress the heart.

What are the causes of this inflammatory process and what are the consequences for cardiac function? We talk about this topic with Dr. Daniela Pini, internist doctor and cardiologist of Humanitas.


The most common causes

In most cases, pericarditis is due to viral infection; more rarely, it is due to bacteria or other pathogens. Other diseases such as cancer, kidney failure or autoimmune diseases such as systemic lupus erythematosus can also cause it.

“Pericarditis can rarely be the result of myocardial infarction. One speaks in these cases of hepistenocardial pericarditis. However, this was more common in the past, before the advent of reperfusion therapy, because pericarditis occurs more easily in the case of large heart attacks. Today, because heart attacks are usually readily treated with reperfusion, they rarely induce pericardial inflammation.

Pericarditis can also arise from surgical interventions in which the pericardium is cut, as typically happens in cardiac surgery: the lesion of the pericardium can trigger an autoimmune reaction,” explained Dr. Pini.

The identification of the underlying cause of pericarditis (whether infectious or not) is decisive in the choice of treatment.


Symptoms of Pericarditis

This condition affects men more than it affects women. The typical symptom of acute pericarditis is chest pain. A pain different from that of the heart attack and tends to change, for example, with breathing, coughing and worsening if you are lying down.


What happens in case of pericarditis?

If the inflammation leads to a rapid accumulation of a conspicuous quantity of liquid inside the pericardial bag, which by nature is not very relaxing, the heart can undergo a compression and no longer be able to fill with blood: in this case there is a cardiac collision, which is a medical urgency.

If, on the other hand, the accumulation of liquid occurs slowly and/or the inflammatory process causes the pericardium to thicken and stiffen, the heart is unable to expand properly, but the situation is less dramatic than the previous one.

“There is no direct damage to the heart muscle, but the bag prevents the heart from filling up and pumping blood, creating a picture comparable to that of heart failure. The symptoms are the same, starting with the edema of the lower limbs.

The problem with pericarditis is that once the inflammation has been resolved, it can reoccur (we talk about recurrent pericarditis), although it rarely becomes chronic,” concluded the specialist.