What is Fibrinous Pericarditis?
The pericardium is a sac filled with fluid that wraps around the heart, like a protective cushion. This sac is made up of two sections, the fibrous pericardium, which is the outer layer, and the serous pericardium, which is split into two parts. The fibrous layer helps hold the heart in place and shield it from infections. It’s made from tough connective tissue. The serous pericardium has two sub-layers, the visceral and parietal layers. The visceral layer helps lessen friction, while the parietal layer gives extra protection.
There are many reasons why the pericardium might become inflamed, and depending on the cause, the inflammation can be classified into five types:
- Fibrinous
- Purulent
- Serous
- Caseous
- Hemorrhagic
A healthy pericardium is shiny, smooth, and glistening. But in fibrinous pericarditis, a type of inflammation, the pericardium becomes rough, grainy and develops many fibrous sticky areas. This usually happens because of factors like injury, surgery, heart attack, kidney disease, diseases involving connective tissue, and cancers.
What Causes Fibrinous Pericarditis?
In simple terms, an injury to the pericardium, which is the sac that surrounds the heart, can lead to inflammation, and the release of fibrin (a protein that helps blood clot) and fluid into the sac. Most of the time, what causes acute pericarditis, or the sudden inflammation of the pericardium, isn’t known. In fact, in 90% of cases, we can’t identify the cause. The other 10% of cases are usually due to things like infections, immune system disorders, high levels of waste products in the blood due to kidney failure (uremia), heart attacks, heart surgery, cancer, injury, and exposure to radiation.
Certain types of cancer, for example, lung and breast cancer, lymphomas, leukemia, and cancers that have spread from other parts of the body, can cause a specific type of pericarditis known as fibrinous pericarditis. Tuberculosis, an infectious disease that mainly affects the lungs, is also a common cause of pericarditis in places where the disease is widespread. There are also several autoimmune and inflammatory diseases, like lupus, scleroderma, rheumatoid arthritis, and mixed connective tissue disease, that can lead to pericarditis.
Risk Factors and Frequency for Fibrinous Pericarditis
The exact number of people who get acute pericarditis, an inflammation of the sac-like layer around the heart, is not known because many cases are believed to go unnoticed. But one study suggests that acute pericarditis could represent up to 5% of visits to the emergency room and cause 0.1% of hospitalizations due to chest pain. This condition usually affects men who are aged between 20 to 50 years old.
Signs and Symptoms of Fibrinous Pericarditis
Acute pericarditis is a condition that most often presents itself through severe chest pain behind the breastbone. This pain is often sharp and worsens when the person coughs, breathes, or sits up straight, but may lessen when leaning forward. This kind of pain is experienced in over 95% of acute pericarditis cases.
An important sign of pericarditis is the pericardial friction rub, a high-pitched, scratching sound that can be heard best when the patient is sitting or leaning forward. This sound corresponds to different parts of the heart’s cycle and is most noticeable during expiration or exhaling at the left lower border of the breastbone.
There are also other important symptoms to keep an eye out for, especially if there’s concern about pericardial tamponade, a severe complication of pericarditis. These include:
- elevated neck vein pressure,
- diminished or muffled heart sounds, and
- lower blood pressure.
It’s also recommended to check for pulsus paradoxus, a decrease of more than 10 mm hg in systolic blood pressure during inspiration, if there’s a concern of pericardial tamponade.
Testing for Fibrinous Pericarditis
Diagnosing your condition requires at least two out of four key signs. A pericardial friction rub, which is a specific sound that a doctor can hear when listening to your heart. The second is a unique type of chest pain that’s sharp and worsens when you breathe in (known as pleuritic chest pain). The third, changes in the readings from an electrocardiogram (ECG, a test that checks your heart’s electrical activity). The last one is the presence of excess fluid in the space around your heart (known as pericardial effusion).
In addition, certain lab tests and imaging studies can support the diagnosis. For example, blood tests may show an increase in your white blood cell count, erythrocyte sedimentation rate (a test that can indirectly measure inflammation in your body), and C-reactive protein (CRP) levels, which are typically high during inflammation or infection.
An electrocardiogram can also be helpful. It detects the electrical signals in your heart and can show specific changes that occur in stages. Stage I might show wide-spread “ST-segment” elevation (which represents certain part of your heartbeat). In stage II, this ST-segment returns to normal. In stage III, there is inversion in traces representing part of your heartbeat (T-waves). Lastly, in stage IV, these T-wave inversions either return to normal or remain inverted.
Another useful test is an echocardiogram, which uses sound waves to create images of your heart. This can help your doctor to see if there’s fluid building up around your heart and assess if your heart’s pumping ability is affected, especially if you have signs of low blood pressure or congestive heart failure. Your doctor will use all these tests and examinations to make a timely diagnosis.
Treatment Options for Fibrinous Pericarditis
Treatment for acute pericarditis, or inflammation of the tissue surrounding the heart, should be tailored to the patient’s particular condition. Patients with this condition usually don’t need to be hospitalized unless they have additional concerning symptoms such as high white blood cell count, fever, recent trauma, a buildup of fluid around the heart, or immune system issues.
Although there aren’t any specific clinical trials, standard treatment for pericarditis is often decided based on the patient’s individual symptoms and medical history. One study found that non-steroidal anti-inflammatory drugs (NSAIDs) and a medication called colchicine were effective in treating patients with the suspected cause being a viral infection or unknown. NSAIDs are medicines like ibuprofen, indomethacin, and aspirin, and they can help with the inflammation and discomfort associated with pericarditis. As these medications can sometimes cause problems in the stomach, particularly for those already prone to such issues, doctors may also recommend a medicine to protect the stomach.
In certain cases, if NSAIDs are not suitable, corticosteroids may be used as the initial treatment for pericarditis. These are particularly used when pericarditis is associated with systemic inflammatory diseases. But, these medications should be gradually decreased to avoid recurrence of pericarditis.
In severe cases of pericarditis where there is a compression on the heart, a procedure known as pericardiocentesis may be needed, which entails draining the excess fluid from around the heart. If the problem reoccurs, a pericardial window, a surgical procedure that creates a permanent opening to let the fluid drain, may be performed. For constrictive pericarditis, where the heart tissue becomes hard and stiff, a surgical procedure to remove this tissue (pericardiectomy) is the preferred treatment.
When it comes to recurring pericarditis, the treatment is often similar to the first episode and may again involve NSAIDs and colchicine. For patients who can’t tolerate NSAIDs, corticosteroids and colchicine may be used. If pericarditis remains problematic, other treatment options may include azathioprine, biological agents, or intravenous immunoglobulins, depending on the patient’s specific situation.
What else can Fibrinous Pericarditis be?
Pericarditis, a condition involving inflammation of the sac around the heart, can sometimes be mistaken for other health issues. These can include heart attacks, issues with the esophagus, or other types of discomfort or pain in the chest area. Therefore, it’s crucial to use specific diagnostic criteria and eliminate the possibility of other severe causes of chest pain.
Other respiratory conditions such as pneumonia, pulmonary embolism, which is a blood clot in the lungs, and pneumothorax, or a collapsed lung, can also cause a type of chest pain known as pleuritic chest pain. These conditions should also be accounted for when diagnosing pericarditis.
What to expect with Fibrinous Pericarditis
The outlook for acute pericarditis, which is a sudden inflammation of the pericardium (the sac-like covering of the heart), is generally very good, especially if the cause is unknown or related to a viral infection. Most of these cases get better and don’t come back. However, in the case of purulent pericarditis, a type of pericarditis caused by pus-filled fluid in the pericardium, the outcome depends on what caused it and how it is treated.
Possible Complications When Diagnosed with Fibrinous Pericarditis
Pericarditis, an inflammation of the sac-like covering around the heart, can lead to three potential complications due to pressure on the heart. Cardiac tamponade is one such complication, which occurs when the pressure in the pericardial sac becomes so high that it prevents the right side of the heart from filling with blood. This is a dangerous condition that requires immediate medical attention.
Another potential complication is constrictive pericarditis, which happens when scarring and loss of elasticity in the pericardial sac hinder the heart’s diastolic filling – the phase when the heart relaxes and fills with blood.
The third possible complication is effusive-constrictive pericarditis. This condition occurs when there is a combination of constrictive physiology, where the heart’s normal function is impaired, and a pericardial effusion, which is the accumulation of excess fluid in the pericardial sac. This gives rise to a mixed picture of heart dynamics.
Complications of Pericarditis:
- Cardiac tamponade, which prevents the right side of the heart from filling with blood
- Constrictive pericarditis, which injures the heart’s ability to fill with blood during relaxation
- Effusive-constrictive pericarditis, which mixes impaired heart function and excess fluid in the sac around the heart
Preventing Fibrinous Pericarditis
If you’re experiencing chest pain that resembles pericarditis, it’s essential to get immediate medical care. Pericarditis is a condition where the sac-like covering around the heart gets inflamed, and if it gets severe, it can squeeze the heart and become life-threatening. Sudden pericarditis can’t typically be prevented, but we can treat it. If you faint or find yourself breathing rapidly, these could be signs that the pericarditis is getting worse.