Pericarditis – types, causes, treatment

The formation of the names of diseases follows a certain logic. Inflammatory diseases are indicated by adding the suffix „-it, -itis“ to the Latin name of the organ. For example, the word pericarditis means inflammation of the outer covering of the heart, myocarditis – inflammation of the heart muscle, meningitis – inflammation of the soft brain membranes, pharyngitis – inflammation of the throat, gastritis – inflammation of the stomach, duodenitis – inflammation of the duodenum, colitis – inflammation of colon, pyelonephritis – inflammation of the renal pelvis, glomerulonephritis – inflammation of the kidney glomeruli, hepatitis – inflammation of the liver, etc. This rule also has exceptions: angina, bronchopneumonia.

Types of pericarditis


Inflammation is divided into two main types: acute and chronic. Acute inflammation is characterized by the outpouring of exudate (bloody, inflammatory fluid) in the focus of inflammation. Along with it, leukocytes (white blood cells) fall into the inflamed area. Their main function is to absorb and destroy microbes (the most common causes of inflammation). The inflammatory fluid accumulates in the interior (parenchyma) of the organ or on its surface. Depending on the composition of the exudate, there are different types of pericarditis – serous, fibrinous, purulent, hemorrhagic.

In fibrinous inflammation, the fluid poured into the focus of inflammation contains a lot of fibrin. Fibrin is a factor of the blood coagulation system and is found in the blood plasma in the form of its inactive precursor fibrinogen. In severe course of acute inflammation, fibrinogen leaves the blood vessels, enters the tissues, turns into fibrin and covers the surface of the organ as a whitish (off-white, white with some tint) plaque. When this happens on the outer surface (pericardium) of the heart, the disease is called fibrinous pericarditis. Such inflammation often develops in rheumatism.

Causes of pericarditis

Fibrinous pericarditis

Fibrinous pericarditis is an acute inflammatory process of the outer covering of the heart – the pericardium. The causes of this inflammation can be viruses and bacteria, but the majority of fibrinous pericarditis is "sterile". In these cases, the inflammation develops secondarily, most often as a result of diseases with immune genesis. An example of such a disease is rheumatism, which affects all three layers of the heart wall. The other group of "sterile" fibrinous pericarditis develops when toxic metabolic products accumulate in the pericardial sac, which the body has not been able to remove through urine. This happens often in nephrosclerosis.

How does severe fibrinous pericarditis – Cor villosum occur?

The heart rests in a dense and strong sac of connective tissue called the pericardial sac. Cardiac activity is a rhythmic alternation of contraction (systole) and relaxation (diastole) of the entire heart. During systole, blood is pushed from the heart to the aorta and through its main branches, the arteries, to the organs of the whole body. During diastole, the heart cavities are filled with blood from the large venous vessels that enter the atria.

During systole, the heart muscle contracts and the external size of the heart decreases, and during diastole, the heart expands and increases in size. Therefore, when relaxing, the heart fills the pericardium and touches it. During contraction, the heart contracts and its surface separates from the sac. During the next diastole, the heart again sticks to the pericardium, and during the next systole, it separates from it.

Fibrin is a „sticky“ substance, a blood protein from the blood clotting system. When poured over the surface of the heart in large quantities, it covers the pericardium as a thin layer of sticky thick fluid. As the heart muscle rhythmically contracts and relaxes, fibrin adheres to the surface of the heart and the inner surface of the pericardium. Because it is sticky, as the two surfaces touch and separate during cardiac activity, fibrin begins to drain as hairs (threads) over the surface of the heart and over time the characteristic appearance of a „hairy“ or „ciliated“ heart (cor villosum). This is the most severe degree of fibrinous pericarditis.

Under the microscope, fibrin exudate is seen as pink ribbon-like deposits on the surface of the heart.

Fibrinous pericarditis

You can get an accurate idea of the mechanism of occurrence of cor villosum in the following way. Chew 2-3 pieces of gum well and squish them firmly until they are soft in your mouth. Your gum is ready for the experiment when it has become as sticky as possible. Now take it out of your mouth and place it between your two palms. Now press your hands firmly together and spread the gum well. Start clapping your hands slowly. Does the gum run out in clumps between your palms? This is also how the ciliated heart occurs in fibrinous pericarditis.

Treatment of pericarditis

Treatment of acute pericarditis depends on the cause of its occurrence. In the case of a viral infection, antiviral and anti-inflammatory medical supplies are used, in the case of a bacterial infection, antibiotic treatment is carried out, in the case of rheumatism, uremia – treatment of the main disease.

The outcome of acute fibrinous pericarditis can be in two directions. In the first variant, the fibrin exudate is resorbed and the heart is completely restored. In the second, connective tissue grows and adhesions remain between the surface of the heart and the pericardial sac. The so-called armored heart. These adhesions create difficulties for the normal heart function and sometimes require surgery to remove them.

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