Rheumatic Pericarditis: Understanding Its Clinical Manifestations

Multi-Organ Involvement in Rheumatic Fever

Rheumatic fever, the underlying cause of rheumatic pericarditis, is a systemic inflammatory disease that can affect multiple organs. Commonly involved areas include the joints, skin, subcutaneous tissues, brain, and most critically, the heart. This widespread impact highlights the importance of a comprehensive clinical evaluation when diagnosing patients suspected of having rheumatic fever.

Signs and Symptoms of Pericardial Inflammation

When rheumatic fever affects the pericardium, it triggers a series of inflammatory responses that manifest in several key symptoms:

Fever

One of the primary indicators of pericardial inflammation is fever. Patients may experience varying degrees and patterns of fever, which can range from low-grade to high-grade. This symptom often persists until appropriate anti-inflammatory treatment is initiated.

Chest Pain

Sharp, stabbing pain behind the sternum or in the precordial region is a hallmark of pericarditis. In some cases, the pain may be dull rather than sharp. It typically worsens with deep breaths, lying down, or coughing, and may improve when sitting up or leaning forward.

Cardiac Tamponade and Its Consequences

As inflammation progresses, fluid may accumulate in the pericardial sac, leading to pericardial effusion. When this fluid builds up rapidly or in large amounts, it can compress the heart and impair its ability to pump blood effectively—a condition known as cardiac tamponade. This can result in reduced cardiac output, signs of heart failure, and congestion in other organs. Additionally, the enlarged pericardium may press on adjacent structures such as the lungs and trachea, potentially causing respiratory symptoms or cough due to pulmonary congestion.