4 signs of acute dry pericarditis

Pericarditis is one of the most common painful conditions of the pericardial tissues. Often, pericarditis remains undiagnosed, they can occur both asymptomatically and accompanied by chest pain. By their origin, they are a complication of a disease and rarely occur on their own. There are fibrinous (dry) and exudative (effusion) types of pericarditis, which can be both its forms and phases of the course. In the second case, the fibrinous type represents the first and milder phase of inflammation. Dry pericarditis can pass without consequences with timely treatment and elimination of the causes. If he has time to go into exudative, then the prognosis will worsen significantly.

What is pericarditis and why "fibrinous"

The pericardium is the pericardial tissue, part of the lining of the heart that, among other things, attaches the heart to the sternum. The ending "itis" always means inflammation of the tissues, respectively, pericarditis is an inflammation of the pericardium. Inflammation can occur with or without a so-called effusion, or release of fluid (also called exudate). Just as wet and dry coughs differ (depending on the condition of the inflamed mucous membranes), inflammation of any tissue can be accompanied by more or less secretions.

The mechanism of inflammation of the pericardium is arranged in such a way that the effusion occurs in any case, but in the dry form (or stage) it is absorbed. In this case, after absorption, fibrin remains on the surface of the pericardial tissue. Over time, fibrin accumulates and then coalesces. If you look at this process "from the inside", then the surface of the pericardium becomes rough and ceases to be shiny.

The word effusion means the discharge or "outpouring" of fluid during inflammation or other painful process, as well as the result of this process - the fluid itself released.

The word exudate is partly synonymous with the word effusion: exudate is an effusion during inflammation. The composition of the effusion includes dense particles, primarily protein particles, which remain on the surface after absorption. This precipitate is called fibrin (from the word "fiber" - fiber).

If the pericarditis is still dry, then this suggests that not all pericardial tissues are involved in inflammation and that is why they are able to absorb effusion. If the entire pericardium is involved, immediately or over time, then there is already an effusive type of inflammation, which can pose a certain threat to life.

Inflammation of the pericardium as a whole also differs in the nature of the course - acute or chronic.

What causes fibrinous pericarditis

Pericarditis rarely occurs on its own and is usually caused by an infectious or autoimmune disease.

• rheumatoid arthritis;
• allergies;
• fungal diseases;
• tuberculosis;
• connective tissue diseases;
• metabolic disorders, for example, with gout;
• lack of vitamin C;
• treatment with glucocorticosteroids (which is sometimes, on the contrary, an option for the treatment of pericardial inflammation);
• blood diseases.

Also, pericarditis can be one of the consequences of a heart attack, oncology, or radiation therapy for oncology.

Some people are born without a pericardium, and this does not significantly affect the quality of life, at the same time, inflammation of the pericardium can be the cause of death, most often indirectly and with a long course. Inflammation of the pericardium can involve myocardial tissue in the process.

The identification of a dry form of inflammation should be the reason for the examination and identification of a possible cause.

What indicates fibrinous pericarditis

The main manifestation of acute fibrinous pericarditis is chest pain, which does not have a specific localization point. By nature, it can be a strong, “tearing” pain or dull and squeezing, sometimes radiating to the abdomen, less often to the shoulder or neck. It is characteristic that the pain during inflammation of the pericardium reacts to movement and breathing - it intensifies with a deep breath, coughing, and movement. In addition, pericardial pain is aggravated by lying down and relieved by sitting forward. Pain can occur in the form of attacks, sometimes of short duration. If the dry form turns into an exudate, then there will be no such pain in the future. Also, in an acute course, fever, subfebrile temperature (37 or slightly higher) can be recorded.

• dry cough;
• feeling of fear;
• shortness of breath, feeling of lack of air;
• feeling of a sinking heart;
• more or less constant malaise, increased sweating, muscle pain and other general symptoms.

As you can see, the first four symptoms themselves can be subjective and caused by the fact of pain and the inability to take a deep breath, and the symptoms of the last point can accompany any disease. Therefore, without diagnosis and on the basis of symptoms alone, pericarditis cannot be established, since it is indistinguishable from panic attacks or neuralgia and neuropathy. On the other hand, similar pain can be observed in deadly conditions such as pulmonary embolism, angina pectoris.

Please note that there is no way to distinguish pain during a panic attack (if they are observed for the first time and are accompanied by pain), pericardial pain and, for example, a heart attack. Distinguishing between pain in pericarditis and pain in coronary heart disease by the nature of the complaints is one of the most difficult tasks, even for a doctor. The widespread opinion that only neuralgic pains respond to movement and breathing is also not true.

Pericarditis also occurs in childhood. A child under three years of age cannot indicate the source of pain, and in this case, the main symptoms are peculiar attacks, which combine frequent shallow breathing, tachycardia, pallor and anxiety.

How dry pericarditis is diagnosed

Thus, an objective diagnosis of dry pericarditis is necessary.

1. During auscultation (listening to sounds in the chest with a stethoscope), there is a “scratching” noise associated with the fact that fibrin causes friction of the pericardial tissues. Noise does not change depending on breathing, it manifests itself especially when the patient leans forward. This sign 100% guarantees the presence of a dry form of pericardial inflammation and is a sufficient condition for making this diagnosis, but it is intermittent and its absence does not mean the absence of pericarditis.
2. The ECG may show ST-segment elevation and T-wave inversion. However, these changes are optional and disappear as inflammation continues and the dry form becomes effusion.
3. Echocardiography reveals thickening of the pericardial layers greater than 2 mm, as well as some effusion. Echocardiography is the main diagnostic method, but the same results can be obtained using more expensive MRI and CT.
4. In blood tests, leukocytosis, an increase in ESR (as with any inflammation) can be observed.

A chest x-ray is not helpful in diagnosing pericarditis, but may help rule out other pathologies.

Treatment of dry pericarditis

Treatment for the dry form does not require hospitalization and is aimed at eliminating the symptoms (relieving pain and inflammation), as well as the causes of inflammation.

• mandatory exclusion of physical activity for periods of pain;
• the use of non-steroidal anti-inflammatory drugs (NSAIDs), Aspirin, Indomethacin, Ibuprofen, if they are ineffective - Colchicine, and if colchicine is ineffective, glucocorticosteroids are prescribed.

Thus, patients with acute dry pericarditis most often have a favorable prognosis and, if the causes of inflammation are eliminated, are completely cured within one to two weeks, and sometimes already on the second or third day. However, if dry pericarditis is not treated in time, it can turn into effusion, which will require longer or even radical treatment up to pericardial puncture.