Pericarditis: symptoms, Covid, treatments, deadly?

"Pericarditis: symptoms, Covid, treatments, deadly?"

Pericarditis is an inflammation of the pericardium, the membrane that surrounds the heart. People vaccinated against Covid have developed pericarditis, especially young men. Definition, symptoms, pain, treatments: all you need to know about pericarditis.

Pericarditis (and myocarditis) are considered to be an adverse effect that may occur “rarely” following vaccination against Covid with an RNA vaccine (Comirnaty from Pfizer or Spikevax from Moderna). "This risk is higher with the Spikevax vaccine", explained the ANSM with a "favorable clinical evolution of the cases". On November 8, 2021, HAS decided to reserve the Moderna vaccine as a primary and booster vaccination for French people over 30 years old. The ANSM also recommends that any vaccinated person showing symptoms such as shortness of breath (dyspnoea), pain in the chest, palpitations (strong heartbeat) or an irregular heartbeat to consult a doctor quickly. What is pericarditis? What symptoms should alert? What treatments?

What are the risks of pericarditis with Covid vaccines?

Since July 2021, pericarditis (and myocarditis) has been considered an adverse effect that may occur "rarely" following vaccination against Covid with Comirnaty (Pfizer) or Spikevax (Moderna). Initial analyzes carried out in Nordic countries and in the United States suggest that among young men, the risk would be higher after Spikevax than after vaccination with Comirnaty. In France, a study whose results were published on November 8, 2021 by the ANSM confirms the existence of an "uncommon" risk of myocarditis and pericarditis within 7 days of vaccination against Covid-19 with a vaccine. RNA like Comirnaty and Spikevax. Concerning the risk of pericarditis, it also appears more marked after the Spikevax vaccine in people under 30 years of age, in particular after the second dose which would be at the origin of an excess of cases reaching around 18 by a million doses in young men. "Reassuringly, the clinical course of cases of myocarditis and pericarditis appears generally favorable. Over the period studied, no deaths were reported among people hospitalized for myocarditis or pericarditis following vaccination." The ANSM recommends that anyone with symptoms such as shortness of breath (dyspnea), chest pain, palpitations (pounding heartbeat) or irregular heartbeat seek prompt medical attention.

What is pericarditis?

Pericarditis is an inflammation of the pericardium, the membrane that envelops the heart and which is made up of two layers (fibrous pericardium and serous pericardium (composed of a parietal layer and a visceral layer)) which delimit within it a cavity usually empty. A lubricating liquid sits between the two leaflets, allowing them to slide over each other without friction. However, inflammation of the pericardium causes irritation, swelling (swelling) and pain. The cavity can be filled with fluid, it is called pericarditis with effusion, as opposed to dry pericarditis when there is no fluid and is not the case. Some types of pericarditis can come on suddenly and last a short time (acute pericarditis) while others progress slowly and last a long time (chronic). Very often its cause remains unknown. This is called idiopathic pericarditis, but it often results from an infection caused by a virus.

Pericarditis with fluid effusion

What are the causes ?

Acute pericarditis can be due to an infection, usually viral, or bacterial. In some cases, it appears as part of the development of cancer, or it may be the consequence of a heart attack, or of a disease such as tuberculosis for example. We speak of chronic pericarditis when it lasts more than 3 months and exerts a resistance to the good activity of the heart, hence its name of constrictive pericarditis.

What are the symptoms ?

Following the cases of pericarditis observed in people vaccinated against Covid, the ANSM recommended that anyone with symptoms such as shortness of breath (dyspnea), chest pain, palpitations (strong heartbeat) or irregular heartbeat to seek medical attention promptly.

What does the pain feel like?

In acute pericarditis, violent and sudden chest pains usually occurring at rest are present, burning or tightness. These pains are typically increased when standing and relieved by leaning forward, during a deep inspiration and during coughing. The pain radiates to the left trapezius. Sometimes the pain can be more discreet. If the origin of the pericarditis is infectious, fever is frequently present. With regard to chronic constrictive pericarditis, the clinical signs are those of the repercussion that it generates on the activity of the heart, and are those of heart failure.

How to confirm the diagnosis?

Signs of pericarditis can be detected from a simple clinical examination, in particular during auscultation of the heart using a stethoscope. A very particular rubbing noise can then alert the doctor, who will proceed to an electrocardiogram which can show specific signs. A chest X-ray may be helpful, but it is echocardiography that confirms the diagnosis of pericarditis, whether acute or chronic. In cases of acute pericarditis, a blood test can help suspect the cause. "Pericarditis is a rare inflammation that accounts for 2% of hospitalizations in cardiology. Most often painful, even if it is not serious in itself, it must still be taken seriously" indicates Dr. Claire Lewandowski, specialist doctor in general medicine.

What are the treatments ?

Pericarditis can be of viral or infectious origin. In this case it is a mild infection which resolves naturally and without sequelae, most of the time after several weeks of rest, associated with taking anti-inflammatories such as acetylsalicylic acid. Other more serious forms of pericarditis sometimes require emergency surgery, especially in cases of pericarditis with a purulent effusion. If cancer or another identified disease is involved, their treatment is essential. More rarely, the pericardium can be reached by a chronic inflammation which can cause an accumulation of fluid or a thickening of the pericardium, especially in the event of tuberculosis, surgical intervention on the heart or after radiotherapy. It then calcifies and gradually compresses the heart. This so-called "constrictive" pericarditis sometimes requires surgery with removal of the pericardium.

Can we do sports?

Pericarditis contraindicates sport for several weeks since it requires rest.

Is pericarditis fatal?

Pericarditis can be fatal when complicated by cardiac tamponade (due to excessive fluid) or generalized infection (sepsis). It can also be life-threatening in people with heart disease or poor health.

Pericarditis and CovidWhat is pericarditis?CausesSymptomsPainDiagnosisTreatmentsSportIs pericarditis fatal?Pericarditis (and myocarditis) is considered a...

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