Viral pericarditis is a condition where the sac-like layer (pericardium) around the heart is inflamed due to complications from viral infections, mainly from echovirus or coxsackievirus. The job of the pericardium is to protect, restrain and lubricate the heart, and determine cardiac filling patterns.
Pericarditis can be divided into infectious and non-infectious categories. In the infectious category, viral infections are the identifiable or possible causes. Acute viral pericarditis can develop based on the severity of the infection. Its development is sudden and could last up to many months. In viral pericarditis, excess fluid can gather in the space between the pericardial layers; this is known as pericardial effusion. The membranes around the heart then become swollen and red.
The causes of viral pericarditis primarily relate to viral infections.
Although coxsackieviruses are usually responsible for viral pericarditis, other viruses like the Epstein-Barr virus, influenza virus, and the human immunodeficiency virus can also be the cause of the disease.
Myocarditis usually accompanies viral pericarditis, unlike other viral infectious diseases. Up to 20% of patients with HIV infections show pericardial abnormalities. Tuberculosis has also been shown to cause 7% of acute pericarditis cases in developing nations.
Viral pericarditis symptoms are evident in the form of chest pains, difficulty in breathing, dry cough, swelling of the ankles or feet, fatigue and fever. The most common symptom of this ailment is chest pain that is usually stabbing and sharp. This pain can rise suddenly or slowly and spread out to the arm or the back. It could be made worse when lying flat or when breathing deeply. The characteristics of the pain help the doctor determine if the aliment is pericardial inflammation or angina.
Depending on the location of the inflammation in the lining, the symptoms can vary. If there is pain near the lung tissue, then pain will be experienced as the person breathes deeply. The patient would also experience low blood pressure if suffering from viral pericarditis. Some other signs of viral pericarditis are distant or soft heart sounds or crackling sounds in the lung. These sounds can be heard through a stethoscope.
Before treatment, it is important to properly diagnose viral pericarditis. Apart from telling the direction of the pain, diagnostic testing is also performed to check for viral pericarditis. An electrocardiogram might be suggested to check for pericardium abnormalities, however sometimes normal variants mimic the changes that occur in pericarditis. Chest x-rays may be done to see if there is heart enlargement. The test most often used to confirm the presence of viral pericarditis is an ultrasound or an echocardiography, to look for fluid in the pericardial sac. Blood testing is also recommended to check for infections.
Medication that decreases inflammation is the primary form of viral pericarditis treatment. Anti-inflammatory non-steroidal drugs like ibuprofen or aspirin are administered to reduce inflammation and the accumulation of fluids in the sac. Treatment of the primary cause of viral pericarditis is essential. Surgery is also an option, depending on the severity of the ailment. A procedure known as pericardiocentesis is performed if there is excess fluid in the pericardial sac. This helps relieve pressure caused within the sac. Constrictive pericarditis can also occur due to viral pericarditis, which is the scarring of the space within the pericardial sac. This limits the expansion of the heart to collect blood from the body, thus constricting the heart and not allowing it to dilate it normally. In this case, pericardotomy is performed, in which the pericardium is split open to free up the constriction.
Viral pericarditis ranges from being mild to life threatening. The prognosis is good when the ailment is treated without delay. The recovery period can be anywhere between 2 weeks to 3 months.
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