Inflammation of the connective tissue of the heart can have many causes. It usually manifests as pain behind the sternum and can severely affect cardiovascular function. The pericardium (peri = surrounding, card = on the heart) surrounds the heart muscle as a connective tissue protective mantle. It consists essentially of two skins, with only the inner with the outside of the heart muscle is firmly grown and thus is displaced during its pumping work against the outer skin. Inflammations of the pericardium occur as an independent disease or are accompanying reactions of other processes in the organism.
Causes of pericarditis
The most common cause is an infection - mostly with viruses, more rarely bacteria and other pathogens. Also, the rheumatic fever as complications of infection with certain bacteria (streptococci) can cause pericarditis, often the endocardium and the heart muscle itself (myocardium) are affected. This leads to a malfunction of the immune system in which the defense directed against the body's own tissue - in this case heart tissue - and causes there inflammatory reactions.
The same happens with other autoimmune diseases such as rheumatic diseases of the musculoskeletal system and hypersensitivity reactions to drugs, for example. Not infrequently, pericarditis also occurs after a heart attack, with an early form demarcated from a late form two to three weeks later within 24 to 48 hours of infarction. Other causes of pericarditis include hypothyroidism, renal insufficiency, connective tissue diseases of the organism, but also growing tumors in the chest or cardiac surgery. In 20 to 30 percent of the diseases, no clear cause can be found.
Symptoms of pericarditis
As with any inflammation, pericarditis is associated with increased blood flow to the tissues involved; Inflammatory cells from the circulating blood accumulate in the tissue and it is released more tissue water. Whether and to what extent it comes to complaints, depends on whether it comes in the contact area of the two pericardial membranes only to inflammatory deposits or whether in the pericardium fluid also accumulates (effusion).
In the former case - a so-called dry pericarditis - breath-dependent chest pain is in the foreground, which typically increases in lying and coughing and decreases in the front over bending. In the second case, the fluid in the pericardium can hinder the normal relaxation and blood filling of the heart muscle so much that the cardiovascular function is impaired (cardiac tamponade) - signs are physical weakness, difficulty breathing and abdominal discomfort.
In the worst case, it comes to a circulatory shock. Basically, one differentiates between an acute pericarditis, which heals after a single treatment and a chronic pericarditis, in which permanent fluid in the pericardium is detected or flares flare up again and again. Both forms can be both mild and - as described above - lead to acute life-threatening situations through pericardial effusion. However, in the acute form, the fluid accumulation is usually more severe, as it is very pronounced (sometimes up to over a liter) and forms so quickly that the heart can not compensate for this. Disruption of the heart function leading to cardiovascular shock with fatal outcome can be the result.
A special form of the chronic form represents the so-called armored heart, in which the pericardium shrinks and scarred by recurring inflammatory reactions, thereby losing its elasticity and leaves the heart like a rigid coat no more opportunities for development.