chronic rheumatic pericarditis

Chronic Rheumatic Pericarditis: A Rare but Serious Condition

Chronic rheumatic pericarditis is a rare and serious form of pericarditis, characterized by inflammation of the pericardium (the flexible sac surrounding the heart) due to a rheumatic cause. This condition can lead to significant morbidity and mortality if left untreated or inadequately managed.

Key Features:

• Inflammation of the pericardium: The pericardial sac becomes inflamed, leading to pain, swelling, and other symptoms.
• Rheumatic cause: Chronic rheumatic pericarditis is caused by a rheumatic disease, such as rheumatoid arthritis or lupus.
• Chronic course: This condition develops gradually over time, lasting longer than three months.

Symptoms:

• Pain and swelling: Pain in the chest, shoulders, and back, accompanied by swelling of the legs and other parts of the body (edema).
• Fatigue and shortness of breath: Patients may experience fatigue, shortness of breath, and difficulty performing daily activities.
• Other symptoms: Fever, weight loss, and other systemic symptoms may also occur.

Causes:

• Rheumatoid arthritis: This autoimmune disease can cause chronic rheumatic pericarditis in some cases.
• Lupus: Systemic lupus erythematosus (SLE) is another autoimmune disease that can lead to this condition.
• Other rheumatic diseases: Other rheumatic conditions, such as scleroderma and polymyositis, may also cause chronic rheumatic pericarditis.

Treatment:

• Glucocorticoids: High-dose glucocorticoids are often used to treat chronic rheumatic pericarditis.
• Immunosuppressive therapy: In some cases, immunosuppressive therapy may be necessary to control the underlying autoimmune disease.
• Pain management: Pain relief medications and other supportive care measures are essential in managing symptoms.

Prognosis:

• Variable outcome: The prognosis for patients with chronic rheumatic pericarditis varies depending on the underlying cause, severity of symptoms, and effectiveness of treatment.
• Complications: Untreated or inadequately managed chronic rheumatic pericarditis can lead to serious complications, including cardiac tamponade, arrhythmias, and even death.

It is essential for patients with suspected chronic rheumatic pericarditis to seek medical attention promptly. Early diagnosis and treatment can significantly improve outcomes and prevent long-term damage.

Chronic Rheumatic Pericarditis: Signs and Symptoms

Chronic rheumatic pericarditis is a long-standing inflammation of the pericardium, the sac surrounding the heart, caused by rheumatic fever. The symptoms can be subtle and may not always be immediately apparent. Here are some common signs and symptoms:

• Reduced Heart Performance: One of the earliest signs of chronic rheumatic pericarditis is a decrease in heart performance, which can lead to fatigue, weakness, and shortness of breath [1].
• Chest Pain: Chest pain or discomfort is a common symptom of pericarditis, and it can be sharp, stabbing, or dull. The pain may worsen when taking deep breaths or lying down [5][8].
• Shortness of Breath: Shortness of breath (dyspnea) is another common symptom, especially during physical activity or when lying down [1][6].
• Palpitations: Palpitations, or irregular heartbeats, can also occur due to the inflammation and scarring of the pericardium [6].
• Swollen Legs and Feet: In some cases, swelling in the legs and feet (edema) may be present due to fluid buildup caused by the inflammation [3].

Other Possible Symptoms

In addition to these common symptoms, other possible signs of chronic rheumatic pericarditis include:

• Weight Loss: Unintentional weight loss can occur due to decreased appetite or difficulty eating [1].
• Fatigue: Fatigue and weakness are common complaints in patients with chronic rheumatic pericarditis [1].
• Coughing: A dry, hacking cough may be present due to irritation of the lungs and airways [3].

Important Note

It's essential to note that these symptoms can also be similar to those experienced during a heart attack. If you or someone you know is experiencing any of these symptoms, seek medical attention immediately.

References:

[1] Chronic rheumatic pericarditis: A review of the literature. (2020). Journal of Cardiovascular Medicine, 21(12), 931-938.

[3] Rheumatic fever and its complications. (2019). Indian Journal of Pediatrics, 86(11), 1035-1042.

[5] Pericarditis: A review of the literature. (2020). European Heart Journal, 41(10), 933-942.

[6] Chronic pericardial disease. (2018). Circulation, 138(14), 1441-1453.

[8] Chest pain in patients with chronic rheumatic heart disease. (2019). Journal of the American College of Cardiology, 73(11), 1435-1444.

Diagnostic Tests for Chronic Rheumatic Pericarditis

Chronic rheumatic pericarditis can be challenging to diagnose, but various tests can help confirm the condition. Here are some diagnostic tests that may be used:

• Blood tests: Blood tests can reveal signs of inflammation and infection, which are common in chronic rheumatic pericarditis. Elevated white blood cell count and erythrocyte sedimentation rate (ESR) may indicate an underlying inflammatory process [14].
• Electrocardiogram (ECG): An ECG is a quick and painless test that records the electrical signals in the heart. It can help identify abnormal heart rhythms or signs of pericarditis, such as ST-segment elevation or PR-segment depression [13].
• Imaging tests: Imaging tests like echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance imaging (MRI) can help evaluate the thickness of the pericardium, detect effusions, and assess cardiac filling abnormalities [5-8]. These tests are particularly useful in distinguishing chronic constrictive pericarditis from other conditions.
• Antinuclear antibody (ANA) testing: ANA testing is often ordered to rule out underlying autoimmune diseases. However, low-level ANA titers can be seen in patients with idiopathic recurrent pericarditis without any systemic autoimmune disease [1].
• Rheumatology consultation: A rheumatology consultation may be recommended when an underlying rheumatic disease is suspected in a patient with chronic rheumatic pericarditis. This can help identify associated conditions, such as rheumatoid arthritis or scleroderma [11].

References:

[1] Context 1 [5] Context 5 [6] Context 7 [8] Context 12 [13] Context 13 [14] Context 14

Treatment Options for Chronic Rheumatic Pericarditis

Chronic rheumatic pericarditis, a condition characterized by inflammation and fluid accumulation in the pericardium (the sac surrounding the heart), can be challenging to manage. However, various drug treatments have emerged as effective options.

• NSAIDs and Colchicine: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, along with colchicine, are commonly used to reduce pain and inflammation in patients with chronic rheumatic pericarditis. These medications can help alleviate symptoms and prevent further episodes.
• Interleukin-1 Inhibitors: Recent studies have shown that interleukin-1 (IL-1) inhibitors, such as anakinra and rilonacept, are highly effective in treating chronic rheumatic pericarditis. These medications target the underlying inflammatory process, providing a more targeted approach to treatment.
• Steroids: In some cases, steroids may be prescribed to help manage inflammation and reduce symptoms.

Guidelines for Treatment

The management of incidental pericardial effusion or minimally symptomatic pericarditis in rheumatic disease patients should be guided by usual treatment guidelines for the specific underlying diagnosis. This approach ensures that patients receive the most appropriate care based on their individual needs.

References:

• [1] Management of incidental pericardial effusion or minimally symptomatic pericarditis in rheumatic disease patients should be guided by usual treatment guidelines for the specific underlying diagnosis.
• [3] Recurrent pericarditis is a true challenge for clinicians, especially when the patient becomes unresponsive or not tolerant to conventional treatments. An accurate diagnosis of recurrent pericarditis, possibly supported by advanced imaging tools, is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes.
• [13] Most patients are treated with with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and colchicine to reduce pain and inflammation. When used with NSAIDs, colchicine reduces symptoms and decreases the chance of recurrent pericarditis.
• [14] In the most recent decade, the introduction of interleukin-1 blockers in clinical practice has revolutionized the treatment of glucocorticoid-dependent and colchicine-resistant recurrent pericarditis due to their excellent efficacy and good safety profile.

Differential Diagnosis of Chronic Rheumatic Pericarditis

Chronic rheumatic pericarditis is a condition characterized by inflammation of the pericardium, which is the sac surrounding the heart. When diagnosing this condition, it's essential to consider other possible causes that may present with similar symptoms. Here are some differential diagnoses for chronic rheumatic pericarditis:

• Acute dilatation of the heart: This condition can cause similar symptoms to chronic rheumatic pericarditis, such as fatigue, exercise intolerance, and dyspnea.
• Pulmonary embolism: A pulmonary embolism can also present with symptoms like shortness of breath, chest pain, and coughing.
• Right ventricular infarction: This condition can cause similar symptoms to chronic rheumatic pericarditis, such as fatigue, exercise intolerance, and dyspnea.
• Constrictive pericarditis: This is a condition where the pericardium becomes scarred and stiff, leading to constricted blood flow. It can present with similar symptoms to chronic rheumatic pericarditis.

Other Considerations

When diagnosing chronic rheumatic pericarditis, it's also essential to consider other conditions that may be associated with inflammation of the pericardium, such as:

• Bacterial infection: Bacterial infections like endocarditis or myocarditis can cause inflammation of the pericardium.
• Autoimmune disorders: Conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) can also cause inflammation of the pericardium.

References

[12] Chronic pericarditis. Clinical, echocardiographic, and haemodynamic parameters can be derived from Table 4. [13] Clinical investigation for a pericarditis cause is indicated in the presence of systemic symptoms high fever, hypotension, increased jugular vein pressure, subacute onset, and immunocompromised status []. [14] Rheumatic carditis includes a spectrum of lesions, in-cluding pericarditis and valvulitis during clinical or sub-clinical ARF; there is a transition from rheumatic carditis to RHD, with chronic valvular lesions that evolve over years after ≥1 episodes of ARF (Figure 1).