Definition
Pericarditis is an inflammation of the pericardium, the membrane that surrounds the heart. Its function is to protect the heart.
These inflammatory episodes occur intermittently and are interspersed with periods of remission.
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It can be caused by various factors, such as viral infections, autoimmune or autoinflammatory diseases, but more often than not the cause is not identified (idiopathic pericarditis).
Epidemiology
L'épidémiologie varie en fonction de la région géographique et des populations étudiées.
Il s’agit d’une maladie rare. Le risque de récidive après une péricardite aiguë est estimé de 15 à 30% et entre 5 et 10 % des patients risquent des récidives multiples.
Elle affecte des individus le plus souvent jeunes ou d’âge moyen, il n'y a pas de prédominance de sexe.
Genetic
The main causes of recurrent pericarditis are:
Infections:
Viral: such as coxsackievirus infections, herpes, HIV, or other viruses.
Bacterial: in particular tuberculosis.
Fungal or parasitic: rarer and especially in immunocompromised people.
2. Diseases :
-autoimmune: such as systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma or Sjögren's syndrome.
-Autoinflammatory diseases such as familial Mediterranean fever or Still's disease.
4. Chest trauma or thoracic or cardiac surgery may be complicated by acute pericarditis, which may progress to recurrent episodes.
5. Certain cancers such as lung cancer, breast cancer or lymphoma.
6. Sometimes no cause is found, and the pericarditis is considered idiopathic.
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Clinical
Patients suffer from acute retrosternal chest pain that increases on deep inspiration, with fever and sometimes a feeling of tightness in the chest and shortness of breath.
Diagnostic
The diagnosis of recurrent pericarditis is based on :
The presence of chest pain, usually accompanied by fever.
The presence of inflammation in the blood, as demonstrated by blood tests (CBC) and measurement of inflammation markers, principally C-reactive protein (CRP).
Evidence of pericardial effusion (increased pericardial fluid) on cardiac ultrasound, thoracic CT scan or cardiac magnetic resonance imaging (MRI).
In rare cases, a pericardial fluid puncture or even a pericardial biopsy may be performed to confirm the diagnosis and look for specific causes, particularly if inflammatory or infectious diseases are suspected.
Treatment
Treatment aims to relieve pain, treat the condition and prevent recurrence.
The treatment of acute pericarditis is based on:
Non-steroidal anti-inflammatory drugs (NSAIDs) (such as aspirin or ibuprofen). They relieve pain and reduce inflammation. They are combined with colchicine, which reduces the risk of recurrence of pericarditis and is continued for 3 months.
It also includes treatment of the underlying cause, such as an infection.
Treatment of recurrences is based on the same treatment as for the acute form, with Colchicine continued for at least 6 months. Corticosteroids such as prednisone may be prescribed if they are ineffective or contraindicated. However, their long-term use should be avoided because of the potential side-effects. As a 3rd-line treatment, anti-interleukin-1 drugs (Anakinra) are prescribed as subcutaneous injections. Depending on the cause, immunosuppressants may also be used.
In the event of significant pericardial effusion, pericardial drainage may be necessary.