Pericarditis

The pericardium is a double-walled sac filled with fluid that surrounds the heart and the roots of its major blood vessels. It serves several important functions: preventing the heart from becoming overfilled with blood, maintaining the heart's position within the chest cavity, and providing lubrication to reduce friction during heartbeats. When the pericardium becomes inflamed, it is known as pericarditis.

Pericarditis can have various causes and may occur suddenly. While it typically lasts several weeks, in some cases, it can persist for several months before resolving. It can affect anyone.

In some instances, pericarditis can become chronic and resistant to conventional therapy, potentially leading to long-lasting stiffness of the pericardium (constrictive pericarditis). Additionally, flares of pericarditis can result in the accumulation of extra fluid within the pericardial sac (pericardial effusion).

If you're experiencing symptoms related to pericarditis or have concerns about your heart health, it's important to seek care from a medical provider. They can diagnose and manage the condition to ensure your well-being and heart health.

Causes of Pericarditis

The cause of pericarditis is wide, many cases are unknown (idiopathic), likely to be secondary to a recent viral illness that can be as simple common cold that complicated by inflammation of the pericardium and result in pericarditis, other causes although rare are bacterial infections, including tuberculosis, fungal infections and other organisms. Some autoimmune diseases can involve pericarditis, and in some cases, it will be the first presentation of the autoimmune condition, lupus and rheumatoid arthritis are two common examples of autoimmune associated pericarditis. Other common cause with increasing frequency is pericarditis as a result of pericardial layer injury as seen in patients after heart surgeries (post-pericardiotomy syndrome) but can also be as a result of percutaneous procedures such as ablation and more. Similarly, pericarditis can occur after heart attacks (myocardial infarction) and after heart injury. Other causes are secondary to genetic diseases, such as Familial Mediterranean Fever (FMF) and more. Malignancy may complicate with pericarditis, with some cases secondary to radiation therapy or drug side-effects.

Type of Pericarditis

The most common type of pericarditis is acute pericarditis. Other types are defined based on how long symptoms last.

Types of pericarditis include:

• Acute pericarditis: This is the most common type, characterized by sudden onset and lasting a few weeks. Sharp chest pain, often resembling a heart attack, is the primary symptom. Episodes may recur.
• Recurrent pericarditis: This occurs approximately 4 to 6 weeks after an episode of acute pericarditis has resolved, with no symptoms between episodes. The risk of recurrence increases with the frequency of pericarditis episodes.
• Chronic pericarditis: This type lasts for three months or longer.
• Constrictive pericarditis: A complication of pericarditis, where the chronically inflamed pericardium becomes stiff and thickened, constricting and interfering with normal heart function. This condition typically arises from repeated episodes of pericarditis, though it can also be the initial presentation in some cases.

Signs and Symptoms of Pericarditis

The most common symptom is sharp, stabbing chest pain caused by the friction of the inflamed pericardium against the heart. The pain may worsen with deep breaths or lying flat and improve when sitting up and leaning forward. Other associated symptoms include fever, weakness, fatigue, and a dry cough. In complicated cases, swelling in the feet, ankles, and legs may be observed.

Treatment of Pericarditis

The mainstay of therapy for idiopathic pericarditis involves anti-inflammatory medications to reduce pericardial inflammation and relieve pain. High doses of ibuprofen, aspirin, or other anti-inflammatory drugs are commonly used for an extended duration. Colchicine is another frequently prescribed anti-inflammatory medication that helps reduce recurrences. In resistant or recurrent cases, corticosteroids may be used. Your provider may also discuss treatment with agents that reduce inflammation, such as Anakinra and Rilonacept, IVIG, and Azathioprine. Therapy for other causes of pericarditis varies and is targeted for the primary reason.

The Center for Myocarditis and Pericardial Diseases is a multidisciplinary clinic that includes a cardiologist specializing in myocarditis and pericardial diseases, a rheumatologist, a radiologist specializing in cardiovascular imaging, and a heart surgeon consulted in specific cases. This patient-focused approach aims to investigate the cause of pericarditis and guide treatment based on the results. The center focuses on achieving disease remission, reducing recurrences, and monitoring for complications of pericardial disease.

What to Expect at the Center for Pericardial Diseases

Pericardial diseases can stem from a variety of causes, ranging from simple viral infections to complex autoimmune disorders. That’s why specialized care from experts in the field is essential to ensure accurate diagnosis and effective treatment. Here’s what you can expect during your visit to the Center for Pericardial Diseases:

Before Your Appointment

After scheduling your visit, our scheduling team will contact you to gather your medical history and any relevant records. This information helps our clinical team review your case and prepare for your visit. If additional tests are likely to be needed, we’ll take care of obtaining the necessary approvals ahead of time to minimize delays.

On the Day of Your Visit

When you arrive, our process is designed to ensure thorough, personalized care:

1. Initial Assessment:
   • You’ll first meet with a medical assistant who will take your vital signs and perform an electrocardiogram (ECG).
2. Comprehensive Evaluation:
   • You’ll then meet with our clinical team, which includes:
     • An Advanced Heart Failure Cardiologist specializing in inflammatory cardiomyopathy and pericarditis.
     • A Nurse Practitioner with expertise in pericardial diseases.
     • A Registered Nurse dedicated to supporting your care.
3. Additional Testing and Referrals (if needed):
   • Based on your evaluation, you may be asked to undergo blood tests, imaging studies (echocardiography, CT or MRI) , or other diagnostic procedures.
   • Cardiac catheterization may be indicated in cases where constriction is a concern, to better assess the filling pressures inside your heart.
   • If indicated, we’ll coordinate consultations with specialists, such as a rheumatologist for autoimmune conditions or a cardiac surgeon for surgical considerations.
4. Education and Treatment:
   • We’ll provide tailored education about your condition, answer all your questions, and begin appropriate treatments, including medication or advanced therapies, as recommended by the clinical team.

Comprehensive and Coordinated Care

At the Center for Pericardial Diseases, we’re committed to providing thorough, patient-centered care. From your initial evaluation to advanced treatments, our team works collaboratively to develop a personalized plan that addresses your unique needs. We’re here to guide you every step of the way toward improved health and well-being.

Meet Our Team

Our team is passionate about providing exceptional, patient-centered care, and we bring diverse expertise to ensure the best outcomes for each individual. We will coordinate with other providers who need to be involved in your care. Here’s who you’ll meet when you visit us:

Dr. Dor Lotan, MD

Dr. Dor Lotan is an advanced heart failure cardiologist and a renowned expert in pericardial diseases with over a decade of experience. Throughout his career, Dr. Lotan has collaborated with world leaders in the field, contributing to groundbreaking studies that have revolutionized the treatment of pericarditis. His dedication to advancing care for patients has earned him recognition as a thought leader and sought-after speaker at national and international conferences.

Dr. Lotan leads Columbia University’s Center for Pericardial Diseases, where he focuses on developing innovative, tailored treatment approaches to meet each patient’s unique needs. Beyond his expertise in inflammatory heart conditions, Dr. Lotan specializes in heart transplants, mechanical circulatory support, and managing complex immunosuppression therapies for transplant patients. He also performs advanced procedures like hemodynamic heart catheterization.

Dr. Lotan serves on the Board of Directors for the Myocarditis Foundation, where he advocates for research and patient support. His mission is to improve care for patients in New York area and beyond, offering expertise and compassion every step of the way.

Jordan Lindekens, NP

Jordan Lindekens is a nurse practitioner with extensive experience managing heart failure and heart transplant patients. She partners closely with Dr. Lotan at the Center for Pericardial Diseases, sharing a commitment to personalized, patient-centered care. Jordan provides ongoing monitoring for individuals requiring advanced heart therapies, including immunosuppression, ensuring continuity and excellence in care.

Jillian Acosta, RN

Jillian Acosta is a dedicated registered nurse specializing in heart failure and transplant patient care. She joined the Center for Pericardial Diseases to provide continuous, individualized support to patients with advanced cardiac conditions. Jillian is deeply committed to helping patients navigate their care journeys with compassion and expertise.

Dr. Maria Salgado, MD

Dr. Maria Salgado is a rheumatologist with a special focus on inflammatory cardiomyopathy. As a key collaborator with the Center for Pericardial Diseases, she evaluates and treats patients suspected of having autoimmune processes affecting the heart. Dr. Salgado’s unique expertise bridges the fields of cardiology and rheumatology to provide comprehensive, integrated care.

Dr. Hiroo Takayama, MD, PhD

Dr. Hiroo Takayama is the Chief of Adult Cardiac Surgery at NewYork-Presbyterian/Columbia University Irving Medical Center. With over 20 years of experience and more than 4,000 surgical procedures performed, Dr. Takayama is internationally recognized for his work in complex cardiac and aortic surgeries.

As a consultant to the Center for Pericardial Diseases, Dr. Takayama provides expert surgical care for patients requiring pericardial surgery. His innovative approaches and dedication to outcomes research ensure the highest level of expertise for even the most challenging cases.

We’re here to provide compassionate, cutting-edge care tailored to your needs. Whether you’re dealing with pericarditis, heart failure, or other complex cardiac conditions, our team is ready to guide you every step of the way.