Pericarditis is an inflammation of the pericardium, the thin, two-layered, fluid-filled sac that covers the outer surface of our heart.

The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of our heart. It provides lubrication for our heart, shields it from infection and malignancy, and contains our heart in our chest wall. It also keeps our heart from overexpanding when blood volume increases, which keeps our heart functioning efficiently.

Pericarditis usually develops suddenly and may last from weeks up to several months. The condition usually clears up after three months, but sometimes attacks can come and go for years. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion.

When a person has pericarditis, the membrane around the heart is red and swollen, like the skin around a cut that becomes inflamed.

Pericarditis can affect anyone, but it’s most common in men and people assigned male at birth who are between the ages of 16 and 65. An estimated 28 people per 100,000 get pericarditis each year.

Types of pericarditis

• Acute pericarditis: Inflammation of the pericardium that develops suddenly along with the sudden onset of symptoms.
• Chronic pericarditis: Inflammation of the pericardium that lasts for three months or longer after the initial acute attack.
• Constrictive pericarditis: A severe form of pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. Constrictive pericarditis interferes with heart’s normal function. This usually happens after multiple episodes of acute pericarditis over time.
• Infectious pericarditis: develops as the result of a viral, bacterial, fungal or parasitic infection.
• Idiopathic pericarditis: Pericarditis that doesn’t have a known cause.
• Traumatic pericarditis: develops as the result of an injury to the chest, such as after a car accident.
• Uremic pericarditis: develops as the result of kidney failure.
• Malignant pericarditis: develops as result of a cancer growing in the body.

Myocarditis vs. pericarditis

Both of these are types of inflammation in heart, but they’re in different places. Myocarditis is in heart muscle. Pericarditis happens in the pericardium (lining around the heart). Most often, a virus causes myocarditis and pericarditis. Both can give chest pain, but with pericarditis, chest pain should feel better when patient sit up and lean forward. With myocarditis, patient usually feel tired and weak.

Symptoms and Causes

Pericarditis symptoms include chest pain that:

• Is sharp and stabbing (This happens when patient’s heart rubs against patient’s pericardium).
• May get worse when patient cough, swallow, take deep breaths or lie flat.
• Feels better when patient sit up and lean forward.

Patient also may feel the need to bend over or hold his/her chest to breathe more comfortably.

Other pericarditis symptoms include:

• Pain in the back, neck or left shoulder.
• Trouble breathing when lie down.
• Dry cough.
• Palpitations (racing or beating irregularly).
• Anxiety or fatigue.
• Fever.
• Swelling of lower extremities.

Swelling in feet, legs and ankles or shortness of breath may be a symptom of constrictive pericarditis. This is a severe type of pericarditis where the pericardium gets hard and/or thick. When this happens, the heart muscle can’t expand, which keeps our heart from working as it should. Heart can become compressed, which makes blood back up into the lungs, abdomen and legs, leading to swelling and causing symptoms of congestive heart failure, sometime with an abnormal heart rhythm.

Causes of pericarditis

In up to 90% of cases, the cause of pericarditis is unknown. This is called idiopathic pericarditis.

There are many causes of pericarditis:

• A complication of a viral infection, most often a gastrointestinal virus, causes viral pericarditis.
• A bacterial infection, including tuberculosis, causes bacterial pericarditis.
• A fungal infection causes fungal pericarditis.
• An infection from a parasite causes parasitic pericarditis.
• Some autoimmune diseases, such as lupus, rheumatoid arthritis and scleroderma, can cause pericarditis.
• Injury to the chest, causes traumatic pericarditis.
• Kidney failure causes uremic pericarditis.
• Tumors like lymphoma causes malignant pericarditis.
• Genetic diseases such as Familial Mediterranean Fever (FMF).
• Allopathic immunosuppressants (This is rare).

Risk of pericarditis is higher after:

• A heart attack.
• Open heart surgery (post pericardiotomy syndrome).
• Radiation therapy.
• Percutaneous treatment, such as cardiac catheterization or radiofrequency ablation (RFA).

In these cases, it’s likely that the inflammation of the pericardium is an error in the body’s response to the procedure or condition. It can sometimes take several weeks for symptoms of pericarditis to develop after bypass surgery.

Diagnosis

Sharp pain in the chest and back of the shoulders that feel better when patient sit up and lean forward, and chest pain with breathing are two major clues that patient may have pericarditis and not a heart attack. Ask about symptoms and medical history and review patient’s history of heart conditions, surgery and other health problems that could put him/her at a higher risk of pericarditis.

Listen to the heart. The rubbing of pericardium’s inflamed lining causes a rubbing or creaking sound called the “pericardial rub.” They’ll be able to hear it best when patient lean forward, hold his/her breath and breathe out. Depending on how bad the inflammation is, you may also hear crackles in patient’s lungs, which are signs of fluid in the space around the lungs or extra fluid in pericardium.

Patient may need one or more tests, such as:

• Chest X-ray to see the size of patient’s heart and any fluid in the lungs.
• Electrocardiogram (ECG or EKG) to look for changes in heart rhythm. In about half of all people with pericarditis, providers see some characteristic changes to a normal heart rhythm. Some people don’t have any changes or may be temporary changes.
• Echocardiogram (echo) to see how well patient’s heart is working and check for fluid (a pericardial effusion) around the heart. An echo will show the classic signs of constrictive pericarditis, including a stiff or thick pericardium that constricts heart’s normal movement.
• Cardiac MRI (with gadolinium – a contrast agent) to check for extra fluid in pericardium, pericardial inflammation or thickening, or compression of heart.
• CT scan to look for calcium in the pericardium, fluid, inflammation, tumors and disease of the areas around the heart. Uses iodine dye during the test to get more information about the inflammation. This is an important test for patients who may need surgery for constrictive pericarditis.
• Cardiac catheterization to get information about the filling pressures in the heart. This test can confirm a diagnosis of constrictive pericarditis.
• Blood tests can help make sure that patient not having a heart attack, see heart’s overall health, test the fluid in the pericardium and help find the cause of pericarditis. It is common that sedimentation rate (ESR) and ultra-sensitive C reactive protein levels (markers of inflammation) to be higher than normal. Check for autoimmune diseases like lupus and rheumatoid arthritis.

Allopathic Treatment for pericarditis

Allopathic treatment for pericarditis depends on the suspected cause. Patient might need to have the fluid drained. If patient have constrictive pericarditis, he/she may need surgery.

Allopathic medications for pericarditis

Allopathic treatment for acute pericarditis may include medication for pain and inflammation, such as ibuprofen or high-dose aspirin. Depending on the cause of pericarditis, patient may need antibiotic or antifungal medication.

If patient has severe symptoms that last longer than two weeks, or they clear up and then return, prescribe anti-inflammatory drugs for example colchicine. Colchicine can help control the inflammation and prevent pericarditis from returning weeks or even months later. Also prescribe steroid medicine for example prednisone, especially if patient have kidney disease that makes it difficult for him/her to take ibuprofen and colchicine.

In case of large doses of ibuprofen, prescribe medications to ease gastrointestinal (side effects) symptoms. In case of large doses of nonsteroidal anti-inflammatory drugs (NSAIDs), patient will need frequent follow-up appointments to look for changes in kidneys and liver function.

If patient has chronic or recurrent pericarditis, he/she may need to take NSAIDs or colchicine for several years, even if patient feel well. A diuretic usually helps get rid of the extra fluid constrictive pericarditis causes.

You may also advise with steroids or other allopathic medications azathioprine, IV human immunoglobulins or anakinra or rilonacept.

If pericarditis is caused by cancer, the most effective treatment is to treat the cancer.

Procedures and surgeries for pericarditis

When fluid builds up in the space between the pericardium, it can cause a condition called pericardial effusion. If the fluid builds up quickly, it can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. Cardiac tamponade is a medical emergency that requires prompt diagnosis and treatment.

This sudden buildup of fluid in between the layers of the pericardium keeps your heart from working like it should and can cause your blood pressure to drop. Cardiac tamponade is life-threatening, that’s why needs to drain the fluid immediately.

If fluid builds up in pericardium (pericardial effusion) and compresses heart, it may be time for pericardiocentesis (long, thin tube/catheter to drain the extra fluid). Echocardiography or a CT scan helps guide the catheter and a needle to the pericardium.

If it’s hard to drain the fluid with a needle, perform pericardial window (a minimally invasive surgical procedure). Make an opening in the pericardium through a small chest incision to drain fluid from the pericardium.

If patient has constrictive pericarditis, he/she may need to have some of the pericardium removed – called a pericardiectomy. It’s important with patients who develop scar tissue in their pericardium. It’s not normally for patients who have active inflammation and chest pain from pericarditis.

Surgery isn’t usually used as a treatment for patients with pericarditis that keeps coming back because inflammation makes healing after surgery difficult.

Homeopathic Treatment for Pericarditis

Colchicum Autumnale

Violent palpitation of the heart. Pericarditis: Pressure and oppression in the region of the heart, as if an attack of apoplexy threatened. Difficulty of respiration, and oppression at the chest, with anxiety; relieved by bending forward. Tensive, pressive, and periodical oppression of the chest; frequent pressure in small spots in the chest. Shootings in the chest, sometimes on breathing. Tearing in the chest, with obtuse lancinations. Pain, as of excoriation in the chest, on being touched and during movement. Tingling in the chest. Tickling in the pharynx, which excites a small dry cough. Frequent short and dry cough. Nocturnal cough, with involuntary emission of urine. Hoarseness in the morning with roughness of the throat.

Pyrogenium

Pericarditis: Pain in region of left nipple, as if in heart; tachycardia; pulse 120/S. Heart tired as after a long run; increased action. Every pulsation felt (painlessly) in head and ears. Sensation as if heart enlarged, distinct consciousness of heart. Sensation as if heart too full of blood. Violent, tiresome heart action. Palpitation or increased action without corresponding increase of temperature. Loud heartbeats; audible to herself and others. Whizzing and purring of heart. Cardiac asthenia from septic conditions. Ecchymoses on heart and pericardium.

Burning in larynx and bronchi, pain in occiput, stitching in small of back. Pain in lung and shoulder. Cough, night-sweats. Severe contracting pain within lower sternum.

Apis melifica

Pericarditis: Sudden pain just below the heart, soon extending toward chest, with suffocation. Very feeble action of the heart; violent beats, shaking the whole body; intermittent beats. Region of heart sensitive to least pressure; rasping sounds of systole and diastole unmistakably audible. Palpitation of heart from scanty secretion of urine. Pulse: almost imperceptible at wrist; accelerated and full; very frequent and hard; wiry; irregular and slow pulse; intermittent.

Respiration hurried and difficult. Edema glottidis. Feeling of constriction causing a single, spasmodic, hacking cough at short intervals. Violent cough, deep, hard ringing, excited by constricted feeling in throat, but reaching down to lungs, the upper part of which are very sore and sensitive.

Hydrothorax. Sensation of soreness in the chest, as from a bruise. Oppression of the chest, shortness of breath, especially when ascending. Dull, aching pain near the middle of the sternum, with sensation of fulness in the chest and short breath. Burning, stinging pain.

Digitalis

Tachycardia, palpitations that can be heard, anguish, and contraction in the sternum. Very slow pulse or irregular and intermittent pulse. Dull uneasiness in various parts of heart region, with sensation of weakness in forearm. Sudden sensation as though heart stood still, with great anxiety and necessity for holding breath; single, violent, slow heartbeats, with sudden violent heat in occiput, and transient unconsciousness. Oppression must breathe deeper. Attacks of angina brought on by any slight careless movement. Cyanosis.

Hollow, spasmodic cough. Dry cough, with pains in the shoulders and arms. Sensation of soreness in the chest. Respiration painfully restricted, especially when lying down, or when walking or seated. Cardiac asthma, pressure on the chest from keeping the body bent. Tension in the chest, with necessity to breathe deeply. Contractive pain in the chest when sitting with the body bent.

Crataegus Oxyacantha

Faintness and collapse. Heart failure in hypertrophy and valvular disease. Palpitation and rapid action of heart. Angina pectoris, pulse strong and forcible; indications of hypertrophy. Hypertrophy from overexertion; from alcoholic, venereal and other excesses. Heart collapse in typhoid. Heart dropsy.

Hepar Sulphuris

Violent palpitation of the heart, with fine stitches in the heart and l. half of chest. Irritability of the heart. Soreness in the chest. Attacks of suffocation, which force the patient to throw back the head. Shortness of breath. Weakness of the chest – cannot talk. Spasmodic constriction of the chest. Frequent want to breathe deeply. Violent pulsation of the carotid arteries. Burning, shooting pain in the region of the loins.

Arsenicum Album

Violent and insupportable throbbing of the heart, chiefly when lying on the back. Irregular beatings of the heart, sometimes with anguish. Cramp in the heart. Heart-beats irritable. Palpitation with anguish, cannot lie on back. Palpitation after suppressed herpes or foot-sweat. Angina pectoris. Hydropericardium. Pericarditis. Fatty degeneration. Dry cough, sometimes deep, fatiguing, and shaking. Shortness of breath, difficulty of respiration, choking, dyspnea and attack of suffocation, sometimes with cold sweat, spasmodic constriction of the chest. Constriction and compression of the chest, sometimes with great anxiety, inability to speak, and fainting fits. Tension and pressure in the chest. Stitches, shooting and pressing in the sternum. Chilliness or coldness in the chest. Shivering, or great heat and burning in the chest. Yellowish spots on the chest.

Physostigma Venenosum

Dull pain, uneasiness and distress about the heart. Violent cardiac palpitation, with feeling of pulsation through whole body. Choking sensation with fluttering of heart. Bradycardia – Heart’s action irregular and tumultuous. Pulse: variable; accelerated; small, frequent, slow, feeble, intermittent. Pericarditis.

Slight constant inclination to cough from filling lungs. Labored, sighing respiration, yawning. Stitches in the chest. Cannot fill lung as inspiration = dull pain at left apex > by pressure. Stitches under inferior angles of scapulae during expiration. Heavy weight at chest. Twitches across pectoral muscles.

Strichninum

Tightness about precordia. Dull pain shifting along line of aortic arch. Fluttering sensation about heart with faintness. Sudden palpitation. Tumultuous action of heart. Heart fluttering. Pulse: irregular; accelerated; corded, tense, strong; full, rapid; nearly extinct in the paroxysms. Jugular veins distended. Pericarditis.

Spasm of respiratory muscles, breathing irregular, intermittent, difficult. Occasionally spasmodic, explosive cough; dry. Breathing: hurried; difficult; choking; tight; with great pain in precordia; sobbing; moaning. Walls of chest fixed. Oppression. Chest tightness and pain: severe, sharp, contractive, spasmodic, darting, on chest, neck, and back.

Aesculus Hippocastanum

Short cough increased by swallowing and breathing deeply. Raw feeling in chest. Tightness in chest. Cough with sensation of stiffness, oppression, stitches, soreness etc. Pericarditis: Twitching over region of heart – stitches and neuralgic pains especially apex; and forehead. Functional disturbances of the heart from hemorrhoidal complaints.

Aurrum Metallcum

Anxious palpitation of the heart, from congestion to the chest. Beatings of the heart, irregular, or by fits, sometimes with anguish and oppression of the chest. Pain in heart region extending down left arm to fingers. Floundering heart. When walking, the heart seems to shake. Sensation as if the heart stood still. Cough from want of breath at night. Great difficulty of respiration. Paroxysms of suffocation, with constrictive oppression of the chest, falling, loss of sense, and cyanosis. Pain, as if there were a plug placed under the ribs. Great weight on chest – on sternum. Congestion in the chest.

Kalmia Latifolia

Fluttering of heart. Pericarditis. Palpitation: with anxiety, suppressed breathing; with faint feeling; with dyspnea, pain in limbs, stitches in lower chest; right sided prosoplasia. Palpitation up into throat, after going to bed, trembling all over. Severe pain in cardiac region, slow, small pulse (hypertrophy, dilatation, aortic obstruction). Quickened but weak pulse. Pulse: slow, weak; arms feel weak; scarcely perceptible, limbs cold; irregular; remarkably slow; 40 to 48; slow, very feeble.

Noise as from spasm of glottis when breathing. Tickling in trachea. Frequent cough caused by dryness or scraping in throat. Difficult and oppressed breathing with palpitation, anxiety; with pain (angina pectoris). Stitches in lower chest.

Gloninum

Inclination to deep respiration. Desire to take a long, deep inspiration. Sighing. Constriction and oppression of the chest. Oppression of the chest alternating with headache. Palpitation of the heart with heat in the face, accelerated pulse and pulsation of the carotid arteries. Sharp pains in heart. Severe stitches from the heart, extending into the back. Purring noise in region of heart when lying, pulse intermittent.

Ignatia Amara

Nocturnal bradycardia, with shootings in the heart. Throbbing in the chest. Sticking in precordial region on expiration. Cardiac hyperesthesia. Pericarditis. Anxious feeling in precordia; sinking sensation and emptiness at stomach; constriction, with anxiety and disposition to cry.

Desire to draw a long breath. Slow breathing. Difficulty of respiration, and oppression of the chest. Oppressed breathing, alternating with convulsions. Shortness of breath when walking, and cough as soon as one stands still. Sighing respiration. Suffocation on running. Aching of the chest. Constriction of the chest. Shootings in the chest and in the sides.

Spigelia Ant

Violent palpitation of heart, perceptible to sight and hearing, often with anxious oppression of chest, improved by curving chest forwards and by sitting down. Pericarditis: Noise in chest, like spinning-wheel. Sudden attack of suffocation, with palpitation of heart and anguish. Heavy aching in region of apex, with feeling as if a dull-pointed knife were slowly driven through it. Organic diseases of the heart; rubbing, bellows sounds. Lancinations in region of heart. Stitches in heart, sometimes synchronous with the pulse. Trembling in heart. Pulse weak, irregular, trembling. Palpitation of the heart with anguish; trembling pulsation of the heart; sympathy of the chest with heart troubles. Visible pulsation of heart. Needle-like stitches in upper dorsal vertebrae.

Dry cough, violent and hollow, caused by irritation low down in trachea, with respiration obstructed, even to suffocation. Shortness of breath. Dyspnea when moving in bed; can only lie on right side; or with the head very high. Danger of suffocation on least movement, and especially on raising arms.

Arnica Montana

Beating and palpitation of the heart. Pain from liver up through chest and down left arm, veins of hands swollen, purplish; angina pectoris. Heart strained; irritable; stitches. Painful pricking in the heart, with fainting fits.

Dry, short cough. Breath fetid; short, and panting. Excessive difficulty of breathing. Respiration short, panting, difficult, and anxious. Rattling in the chest. Oppression of the chest and difficulty of breathing. Shootings in the chest and sides, with difficulty of respiration, aggravated by coughing, but breathing deeply, and by movement, better from external pressure. Burning or rawness in the chest. Sensation of soreness of the ribs.

Caladium Seguinum

Larynx and trachea constriction; impedes deep breathing. Sudden and involuntary cough caused by tickling high up in throat. Oppression of breathing cannot get his breath easily. Asthma alternating with itching, burning rash. Sharp stitches in chest.

Amylenum Nitrosum

Dyspnea and asthmatic feelings. Great oppression and fullness of chest; spasmodic, suffocative cough. Precordial anxiety. Tumultuous action of heart. Pain and constriction around heart. Fluttering at slightest excitement. Superficial arterial hyperemia. Palpitation of the heart especially the flushing and other discomforts at climacteric. Hiccough and yawning. Pericarditis.

Calcarea Flourica

Calc. Fluor removes fibroid deposits about the endocardium and restores normal endocardial structure. Hoarseness. Cough with tickling sensation and irritation on lying down. Spasmodic cough. Chief remedy for vascular tumors with dilated blood-vessels, and for varicose or enlarged veins. Aneurism. Pericarditis. Valvular disease. Tuberculous – toxins attack the heart and blood-vessels.

Aconit Nepalus

Palpitation of the heart, with great anxiety, heat of body, chiefly in the face, and great weariness in the limbs. Shootings in the region of the heart (going upstairs). Pericarditis. Sensation of compression and blows in the region of the heart. Cardiac inflammation. Chronic cardiac diseases, oppressed breathing, stitches in the region of the heart, congestions to the head; attacks of fainting and tingling in the fingers. Fainting with tingling. Pulse full, strong, hard; slow, feeble; threadlike with anxiety; quick, hard, small.

A constant desire to cough, produced by an irritation or a tickling in the larynx. Inflammation of larynx and bronchia. Short and dry cough, principally at night. Angina membranate, with dry cough and quick breathing. Shootings and pains, stitching in the chest on coughing. Short breathing, chiefly during sleep, and on getting up. Breathing painful, anxious, and attended with groans, rapid and superficial, or full, noisy, and with the mouth open. Breathing slow during sleep. Breath hot and fetid. Constriction and anxious oppression of the chest, with difficulty of breathing. Heaviness and of compression at the chest.

Pleurisy and pneumonia with great heat, much thirst, dry cough and great nervous excitability, only somewhat relieved when lying on the back. Itching in the chest. Pains as of a bruise in the sternum and in the sides. Sensation of anguish in the chest, which interrupts respiration.

Absinthium

Cough with liver complaint. Tremor of the heart felt toward the back. Heart thumps; can be heard in scapular region. Cough with liver complaint. Tremor of the heart felt toward the back. Heart thumps; can be heard in scapular region. Hepatomegaly. Spleen diseases.

Abies Canadensis

Breathing labored. Sensation as if the one lung is small and hard. Pericarditis.  Action of the heart labored. Increased action of the heart with distension of the stomach. Pain behind the right shoulder-blade. Weak feeling in sacral region. Feeling as of cold water between the shoulders.

Abrotanum

Cold air causes a raw feeling in respiratory tract. In pleurisy when a pressing sensation remains in affected side, impeding free breathing. Pain across chest sharp and severe in region of heart; rheumatism.  Metastasis of rheumatism to heart. Pulse weak and small.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment but just hints for treatment; every patient has his/her own constitutional medicine.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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