Pericarditis is an inflammation of the pericardium, the membrane that surrounds the heart. Mainly due to a viral infection, it is also one of the rare side effects of certain vaccines against Covid. What are the causes ? Symptoms ? How to cure it?
Pericarditis is inflammation of the pericardium, the membrane that surrounds the heart. Pericarditis can be caused by a bacterial, viral infection (Covid-19 for example, Influenza or Parvovirus B19) or fungalrheumatic fever, rheumatoid arthritis (or rheumatoid arthritis), lupus… This inflammation of the pericardium causes irritation, swelling (swelling) and pain. It is also a side effect may occur “rarely” after an injection of the RNA Covid-19 vaccine (Comirnaty of Pfizer or Spikevax from Moderna). A risk “higher with Moderna’s vaccine“, according to’ANSM. That’s why the High Authority for Health (HAS) has decided to reserve the Moderna vaccine as a primary and booster vaccination for French people over the age of 30. In the majority of cases, the patient’s condition improves on its own (pericarditis resolves on its own) or with the help of treatment. What are the signs of pericarditis? What causes? How is it diagnosed? How to cure it?
Definition: what is pericarditis?
Pericarditis is a inflammation of the pericardium, the membrane that envelops the heart and which consists of two layers (fibrous pericardium and serous pericardium (composed of a parietal layer and a visceral layer)) which delimit within it a usually empty cavity. A lubricating liquid is located between the two sheets, which allow them to slide one over the other without them rubbing. Nevertheless, Inflammation of the pericardium causes irritation, swelling (swelling) and pain.
What is pericarditis with effusion?
The cavity can be filled with liquidWe are talking about pericarditis with effusion.
Diagram of pericarditis with fluid effusion
What is dry pericarditis?
In contrast to pericarditis with effusion the pericarditis is said dried when there is no liquid in the cavity.
What is acute pericarditis?
Some types of pericarditis may come on suddenly and last for a short time (acute pericarditis) while others progress slowly and last a long time: these are chronic pericarditis. Chronic pericarditis lasts longer than 3 months and is often caused by tuberculosis.
What is idiopathic pericarditis?
Very often its cause remains unknown. We then speak of idiopathic pericarditisbut this is often the result of an infection caused by a virus.
What is a constrictive pericardium?
A constrictive pericarditis is characterized by fibrous or calcified thickening of the pericardium. It is a rare pathology, the main causes of which are infection, thoracic radiotherapy and heart surgery. We speak of constrictive pericarditis since the inflammation exerts a resistance to the good activity of the heart. This inflammation can cause accumulation of fluid or thickening of the pericardium, especially in cases of tuberculosis, surgery on the heart or after radiation therapy. It then calcifies and gradually compresses the heart. This pericarditis sometimes requires surgery with removal of the pericardium.
Can pericarditis occur following a Covid?
According to’Medicines Agencypericarditis (inflammation of the membrane surrounding the heart) are caused, most of the time, by a viral infection such as Covid-19. In the majority of cases, the patient’s condition improves on its own or with the help of treatment.
Pericarditis post Covid vaccination: what are the risks?
Since April 2021, cases of myocarditis and pericarditis have been reported following the administration of Covid-19 messenger RNA (mRNA) vaccines. Since July 2021, the pericarditis (and myocarditis) are considered a undesirable effect which can occur “rarely” following a vaccination against the Covid with Comirnaty (Pfizer) or Spikevax (Moderna). Analyzes from Nordic countries and the United States suggest that among young men, the risk seems higher after Spikevax, only after vaccination with Comirnaty. In Francea study whose results were published on November 8, 2021 by theANSM has indeed confirmed the existence of a “infrequent” risk myocarditis and pericarditis within 7 days following a vaccination against Covid-19 with an RNA vaccine such as Comirnaty and Spikevax. Regarding the risk of pericarditis, it also appears more marked after the Spikevax vaccine in people under 30specifically after the second dose which would be at the origin of an excess of cases reaching around 18 per million doses in young men. “Reassuringly, the clinical course of cases of myocarditis and pericarditis appears generally favorable. Over the period studied, no deaths were reported among people hospitalized for myocarditis or pericarditis following vaccination.” In April 2022I’Epi-Phare study also concluded that “cases of myocarditis and pericarditis following vaccination do not appear more serious than those occurring outside of vaccination.“
► The ANSM recommends that anyone with symptoms such as shortness of breath (dyspnoea), chest pain, palpitations (pounding heartbeat) or irregular heartbeat seek prompt medical attention.
What causes pericarditis?
Acute pericarditis may be due to:
- a viral infection (Covid, Influenza, etc.)
- a bacterial infection
- a fungal infection
- the progression of cancer
- a heart attack (a late form of pericarditis triggered by the immune system’s reaction to an injury)
- tuberculosis.
- rheumatic fever
- rheumatoid arthritis (or rheumatoid arthritis)
- systemic (or systemic) lupus erythematosus
- kidney failure
- scleroderma
- heart surgery
- taking certain drugs that weaken the immune system.
What are the symptoms of pericarditis?
Pericarditis can be symptomatic or asymptomatic. If symptomatic, pericarditis can cause:
- A chest or chest pain (main sign of pericarditis) throbbing, oppressive and intense. It usually manifests on the left side of the chest, but can spread to the shoulders and neck.
- heart palpitations
- Difficulty breathing
- Flu-like signs and symptoms (fever, fatigue, etc.)
- A cough
- abdominal swelling
In acute pericarditis, sharp and sudden chest pains usually occurring at rest are present, burning or squeezing. Those pain is typically increased on standing and relieved by leaning forward, during deep inspiration and during coughing. The pain radiates to the left trapezius. Sometimes the pain can be more discreet.
Signs of pericarditis can be detected from a simple clinical examination, in particular during auscultation of the heart using a stethoscope. A very particular rubbing noise can then alert the doctor, who will proceed to an electrocardiogram which can show specific signs. A chest X-ray may be helpful, but it is echocardiography that confirms the diagnosis of pericarditis, whether acute or chronic. In cases of acute pericarditis, a blood test can help suspect the cause. “Pericarditis is a rare inflammation that accounts for 2% of hospitalizations in cardiology. Most often painful, even if it is not not serious in itself, it should still be taken seriously.” says Dr. Claire Lewandowski, a doctor specializing in general medicine.
Pericarditis contraindicates sport for several weeks.
What treatment to treat pericarditis?
Pericarditis can be of viral or infectious origin. In this case, it is a mild infection that resolves naturally and without sequelae, most of the time after several weeks of rest, associated with the taking anti-inflammatories such as for example acetylsalicylic acid. Other more serious forms of pericarditis sometimes require emergency surgerynotably in case of pericarditis with purulent effusion. If cancer or another identified disease is involved, their treatment is essential.
Can you do sports in case of pericarditis?
Pericarditis contraindicates sport for several weeks since it requires rest.
Is pericarditis fatal?
Pericarditis can be fatal when complicated by cardiac tamponade (due to excessive fluid) or generalized infection (sepsis). It can also be life-threatening in people with heart disease or poor health.
Medical form validated by Dr Claire Lewandowski.
Sources: Medicines Agency, French National Authority for Health