Pericarditis

This is the name for a condition in which the membrane that covers the heart (known as the pericardium) becomes inflamed, often as a result of a bacterial or viral infection.

The pericardium

This fluid filled sac surrounds the heart and performs a range of vital functions which include:

Securing the heart in its current position
Acting as a form of protection (shock absorption)
Preventing the heart from over-increasing in size as blood volume increases.

There is a space or cavity within the pericardium –known as the ‘pericardial cavity’which contains fluid that prevents any friction between its membranes.

If the pericardium becomes inflamed it results in severe chest pain but there is likely to be minimum damage to the heart itself.

How does this relate to food poisoning?

Pericarditis can be caused by a bacterial, viral or parasitical infection, for example the salmonella bacteria.

The salmonella bacteria are responsible for an unpleasant form of food poisoning; however, there are other types of bacteria which also cause food poisoning and pericarditis.

These include:

These all cause bacterial food poisoning by means of toxins which are released into the intestine (and sometimes the bloodstream) following the consumption of infected food and/or water.

These cause ‘bacterial pericarditis’.

Causes of pericarditis

There are a variety of causes, most of these being viral infections such as ‘the flu’virus or the herpes simplex virus.

Bacterial infections are another reason which includes the strains of bacteria described above which are responsible for food poisoning.

Other causes include:

Serious injury or accident which involves the chest
Autoimmune disease, e.g. rheumatoid arthritis
Radiotherapy: as part of cancer treatment
Tuberculosis
Cancer
Heart attack
Heart surgery

Men are more likely to be affected than women although this will differ if pericarditis is caused by food poisoning.

In many cases of pericarditis there is no obvious cause. This is known as ‘idiopathic pericarditis’.

Symptoms of pericarditis

The main symptom is chest pain which is usually localised in the centre of the chest and worsens if you take a deep breath or cough. Lying flat also worsens this although sitting upright will ease it.

This pain may spread to your arms, left shoulder or neck.

It is easy to mistake this pain as a sign of a heart attack and, indeed, this is something which many people do. Any sudden chest pain needs to be investigated, irrespective of whether it is pericarditis or another type of heart complaint.

In this situation seek urgent medical advice.

Other symptoms include:

Fever
Coughing
Fatigue
Swollen abdomen and/or legs
Nausea

These may occur as a result of a viral or bacterial illness.

Complications of pericarditis

Complications are rare but do happen so it is as well to be aware of these. They include irregular heart beats (arrhythmia), cardiac tamponade and constrictive pericarditis. Chronic heart failure is another risk.

Arrhythmia

This is an abnormal heart rate or rhythm which can either be too fast or too slow; or where the heart is unable to pump blood which causes it to collapse. These are life threatening conditions which need emergency medical treatment.

Cardiac tamponade

Cardiac tamponade is where there is an excess amount of fluid inside the pericardium which puts pressure on the heart. This prevents it from pumping blood around the body as per normal.

This is a life threatening condition and requires emergency treatment.

Constrictive pericarditis

The tissue of the pericardium becomes scarred and thickens which then compresses (constricts) the heart. This prevents the heart from fully expanding as it beats and affects blood flow around the body.

This results in symptoms of heart disease.

Surgery is required to remove the scarring and to release this compression of the heart.

Chronic heart failure

This is an umbrella term used to describe a range of conditions which affect the ability of the heart to pump blood around the body.

Diagnosing pericarditis

Your GP will examine you, ask you about your symptoms and your medical history. He or she will ask you if you have experienced any recent bacterial or viral infections so mention to him/her if you had food poisoning.

Do this if you have had salmonella poisoning or any of the other three bacterial infections mentioned here.

You will be referred for tests which include:

Blood tests
ECG (electrocardiogram)
Echocardiogram
CT/MRI scans

The last two tests are only carried out if you have developed complications such as constrictive pericarditis.

Treatment for pericarditis

This will depend upon the cause and whether your condition is such that you can be treated at home or require admission to hospital.

If you developed complications then hospital admittance is more than likely and means that your condition can be carefully monitored.

This will depend upon the results of your tests. If, for example, you have undergone an echocardiogram and this shows an excess of fluid around the pericardium plus a weak immune system then hospitalisation will be necessary.

Echocardiogram

An echocardiogram is the name for an ultrasound scan of the heart. This produces accurate images of the heart; its chambers, valves and well (or not) it is working.

The procedure is very similar to that performed during a pregnancy. It consists of a handheld device called a probe which is connected to an ultrasound monitor. This probe is placed onto your chest and moved around.

Ultrasound pulses are transmitted by the probe, through the skin and towards the heart. These then ‘echo’ (or reverberate) back from the heart to an ECG machine via the probe. These echoes appear as a series of images of the heart on the ultrasound monitor.

Medication

If your pericarditis has been caused by food poisoning then you will treated for that as well as the pericarditis. If your food poisoning has a bacterial source then antibiotics can be prescribed. But antibiotics are ineffective against viral food poisoning and other viral infections.

You will be given additional medication which is designed to treat pericarditis which includes non-steroidal anti-inflammatory drugs (NSAIDs), steroids or colchicine.

NSAIDs are effective at easing any chest pain and inflammation in the pericardium. An example of these is ibuprofen.

Steroids are given to block the effects of the immune system, preventing any further release of antibodies and so help to reduce the inflammation. However, they are only prescribed if there is a dangerous build up of fluid within the pericardium or if an NSAID/colchicine is ineffective.

Colchicine is a treatment for gout which is also effective against pericarditis. It works by destroying many of the cells of the immune system that cause this inflammation which then reduces any inflammation within the pericardium.

This is given in recurring cases of pericarditis or if someone is unable to take NSAIDs.

If you have suffered a bout of bacterial food poisoning and suspect that you may have developed pericarditis then contact your GP.