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Pericarditis

Disease Details

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Description: Pericarditis is the inflammation of the pericardium, the thin, sac-like membrane surrounding the heart.
Type: Pericarditis is typically classified as an inflammatory condition affecting the pericardium, the double-walled sac containing the heart. It usually results from infections (viral, bacterial, or fungal), other inflammatory diseases (like rheumatoid arthritis or lupus), injury or surgery to the chest, or unknown causes (idiopathic). It is generally not considered a hereditary condition, and there is no specific type of genetic transmission associated with it.
Signs And Symptoms: Substernal or left precordial pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back) is the characteristic pain of pericarditis. The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and supine positions) or by inspiration (taking a breath in). The pain may resemble that of angina but differs in that pericarditis pain changes with body position, where heart attack pain is generally constant and pressure-like. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety.Due to its similarity to the pain of myocardial infarction (heart attack), pericarditis can be misdiagnosed as a heart attack. Acute myocardial infarction can also cause pericarditis, but the presenting symptoms often differ enough to warrant diagnosis. The following table organizes the clinical presentation of pericarditis differential to myocardial infarction:
Prognosis: Pericarditis typically has a favorable prognosis, especially when it is treated promptly. Most cases are acute and resolve within a few weeks to months with appropriate medical management, including anti-inflammatory medications. However, recurrent or chronic pericarditis can occur and might require long-term treatment. Prognosis can vary depending on the underlying cause, such as infections, autoimmune conditions, or other systemic illnesses. Early diagnosis and treatment are crucial in reducing the risk of complications like cardiac tamponade or constrictive pericarditis.
Onset: Pericarditis is the inflammation of the pericardium, the sac-like covering of the heart. The onset of pericarditis can happen suddenly (acute) or gradually over time (chronic). Symptoms typically include sharp, stabbing chest pain that may spread to the neck, shoulders, or back. Pain often worsens with deep breathing, lying down, or swallowing and improves when sitting up and leaning forward.
Prevalence: Pericarditis is an inflammation of the pericardium, the sac-like covering of the heart. The exact prevalence is not well-established but it is estimated to affect about 0.1% of hospitalized patients and 5% of patients presenting to emergency departments with chest pain of non-cardiac origin. Pericarditis can occur across all age groups but is more commonly diagnosed in adults.
Epidemiology: About 30% of people with viral pericarditis or pericarditis of an unknown cause have one or several recurrent episodes.
Intractability: Pericarditis is not generally considered an intractable disease. Many cases are acute and respond well to treatment, including anti-inflammatory medications. However, some cases can become recurrent or chronic, which may be more challenging to manage but are still treatable with appropriate medical interventions.
Disease Severity: Pericarditis:

Disease Severity: Varies; it can range from mild and self-limiting to severe and life-threatening, potentially leading to complications such as cardiac tamponade or chronic constrictive pericarditis. Symptoms may include sharp chest pain, fever, and pericardial friction rub.

Nan: Not applicable or unknown in this context. Please provide more specific information to address this point accurately.
Healthcare Professionals: Disease Ontology ID - DOID:1787
Pathophysiology: Pericarditis is characterized by inflammation of the pericardium, the sac-like covering of the heart. This inflammation can lead to changes in the structure and function of the pericardium. It typically involves the infiltration of immune cells and the release of inflammatory mediators, which can cause the layers of the pericardium to rub against each other, leading to sharp chest pain. The inflammation may result in an increase in pericardial fluid, known as pericardial effusion. If this effusion is substantial, it can impede the normal filling of the heart and lead to cardiac tamponade, a life-threatening condition. The causes of pericarditis can include infections (viral, bacterial, fungal), autoimmune disorders, myocardial infarction, trauma, or may be idiopathic (unknown origin).
Carrier Status: Pericarditis is an inflammation of the pericardium, the thin sac-like membrane surrounding the heart. It is usually not associated with a carrier status, as it is not a genetic or infectious disease that can be carried and transmitted in that way. The condition often results from infections, autoimmune disorders, chest injuries, or other underlying medical conditions.
Mechanism: Pericarditis is the inflammation of the pericardium, the double-walled sac containing the heart and the roots of the great vessels.

**Mechanism:**
Pericarditis primarily involves the irritation and swelling of the pericardium. This can be caused by infections (viral, bacterial, fungal), autoimmune conditions, trauma, myocardial infarction, or other systemic inflammatory conditions. The inflammation can lead to pericardial effusion, where excess fluid accumulates in the pericardial cavity, potentially progressing to cardiac tamponade, a life-threatening condition where pressure on the heart impairs its function.

**Molecular Mechanisms:**
The molecular mechanisms involve a complex interplay of inflammatory mediators:
1. **Cytokines and Chemokines:** Pro-inflammatory cytokines (e.g., Interleukin-1 (IL-1), Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α)) and chemokines recruit immune cells to the pericardium, resulting in inflammation and tissue damage.
2. **Inflammatory Cells:** Neutrophils, macrophages, and lymphocytes infiltrate the pericardium and release enzymes and reactive oxygen species that exacerbate inflammation.
3. **Complement System:** Activation of the complement cascade contributes to the inflammatory response and cell lysis.
4. **Vascular Changes:** Increased vascular permeability leads to fluid accumulation in the pericardial cavity, contributing to pericardial effusion.
5. **Fibrosis:** Chronic inflammation can result in fibrosis and thickening of the pericardium, potentially leading to constrictive pericarditis, where the heart's normal function is restricted.

Understanding these mechanisms provides insight into potential therapeutic targets to mitigate the inflammatory response and prevent complications.
Treatment: The treatment in viral or idiopathic pericarditis is with aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen). Colchicine may be added to the above as it decreases the risk of further episodes of pericarditis.Severe cases may require one or more of the following:
antibiotics to treat tuberculosis or other bacterial causes
steroids are used in acute pericarditis but are not favored because they increase the chance of recurrent pericarditis
pericardiocentesis to treat a large pericardial effusion causing tamponadeRecurrent pericarditis resistant to colchicine and anti-inflammatory steroids may benefit from a number of medicines that affect the action of interleukin 1; they cannot be taken in tablet form. These are anakinra, canakinumab and rilonacept. Rilonacept has been specifically approved as an orphan drug for use in this situation. Immunosuppressive agents, such as Azathioprine and intravenous immunoglobulins, are a novel therapeutic agent which have been effective in treating and preventing recurrent pericarditis, though research on these therapies is limited.Surgical removal of the pericardium, pericardiectomy, may be used in severe cases and where the pericarditis is causing constriction, impairing cardiac function. It is less effective if the pericarditis is a consequence of trauma, in elderly patients, and if the procedure is done incompletely. It carries a risk of death between 5 and 10%.
Compassionate Use Treatment: Compassionate use treatments for pericarditis are typically considered when standard therapies have failed and the disease is severe or life-threatening. These might include:

1. **Interleukin-1 blockers**: Medications like anakinra (Kineret) and rilonacept (Arcalyst) are being investigated for their effectiveness in treating recurrent pericarditis. Both inhibit interleukin-1, which is involved in the inflammatory process.

2. **Colchicine**: Although often used as a standard treatment, it can also be considered for compassionate use in recurrent pericarditis when patients are refractory to other treatments. It suppresses inflammatory processes and can reduce recurrence rates.

3. **Intravenous immunoglobulin (IVIG)**: This may be used in resistant cases, particularly if an autoimmune component is suspected. IVIG can modulate the immune response and reduce inflammation.

These treatments are typically employed under careful medical supervision and are considered when other approaches have not been successful, have been contraindicated, or are not available.
Lifestyle Recommendations: ### Lifestyle Recommendations for Pericarditis

1. **Rest and Reduced Physical Activity:**
- Engage in adequate rest and limit physical activity, especially during the acute phase of pericarditis to reduce strain on the heart.

2. **Medication Adherence:**
- Follow prescribed medications meticulously, such as anti-inflammatory drugs or colchicine, to manage inflammation and pain.

3. **Avoiding Triggers:**
- Steer clear of activities that can exacerbate symptoms, such as heavy lifting or high-intensity exercise until a healthcare provider gives the go-ahead.

4. **Healthy Diet:**
- Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support overall heart health.

5. **Hydration:**
- Stay well-hydrated, but monitor fluid intake if advised by a healthcare provider, especially if there's concern about fluid retention.

6. **Stress Management:**
- Practice stress-reducing techniques like meditation, deep breathing exercises, or yoga to help manage emotional stress, which can influence heart health.

7. **Regular Follow-ups:**
- Keep up with regular medical follow-ups to monitor the condition and adjust treatment as necessary.

8. **Avoid Alcohol and Tobacco:**
- Limit or avoid alcohol and cease tobacco use, as these can have adverse effects on overall heart health.

9. **Monitor Symptoms:**
- Be vigilant in monitoring symptoms and seek medical attention if there are signs of worsening, such as increased chest pain, difficulty breathing, or fever.
Medication: For pericarditis, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin are commonly used to reduce inflammation and relieve pain. In some cases, colchicine may be prescribed to reduce the risk of recurrent episodes. If NSAIDs or colchicine are not effective, corticosteroids like prednisone may be considered. Antibiotics are necessary if a bacterial infection is the cause. Always consult with a healthcare provider for a treatment plan tailored to the individual's specific condition.
Repurposable Drugs: For pericarditis, several repurposable drugs include:

- Colchicine: Traditionally used for gout, it helps reduce inflammation in pericarditis.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drugs like ibuprofen and aspirin are commonly used to alleviate pain and inflammation.
- Corticosteroids: Medications such as prednisone may be used for severe or recurrent cases when other treatments are ineffective.

N/A (nan): No additional information provided.
Metabolites: Pericarditis is inflammation of the pericardium, the sac surrounding the heart. This condition can alter the levels of certain metabolites within the blood, such as elevated C-reactive protein (CRP) and increased levels of troponins, which are typically associated with cardiac injury or stress. However, the term "nan" does not correspond to a recognized metabolite or relevant medical terminology in the context of pericarditis. If you meant "non" or "none," clinicians typically do not refer to pericarditis by those terms. Further details or context might be needed to provide a more precise answer.
Nutraceuticals: Nutraceuticals for pericarditis have not been extensively studied. While conventional treatments typically involve anti-inflammatory medications and colchicine, some dietary supplements may offer complementary benefits. Omega-3 fatty acids, commonly found in fish oil, have anti-inflammatory properties that could be supportive. Other antioxidants, such as vitamins C and E, could also help reduce inflammation, but more research is needed to confirm their efficacy specifically for pericarditis. It is essential to consult a healthcare provider before starting any new supplements.
Peptides: Pericarditis is an inflammation of the pericardium, the thin sac surrounding the heart. The role of peptides in pericarditis treatment is an emerging area of research. Some peptides with anti-inflammatory and cardioprotective properties are being studied for their potential to reduce inflammation and prevent damage. However, their use is not yet standard practice in clinical settings.

Nanoparticles (nan) are also being investigated as potential delivery systems for drugs targeting pericarditis. Nanoparticles can enhance the delivery and efficacy of anti-inflammatory and immunomodulatory agents while minimizing side effects. These innovative approaches are still largely in the experimental phase but hold promise for future therapeutic strategies.