OfMauro Pepi
A minimum “echo-free” space at the level of the pericardium should not cause concern and does not cause functional disorders of the heart: very often it is physiological
I had a cardiology visit which came back normal. However, a pericardial detachment emerged; the doctor told me it was due to Covid and not to worry, but I'm not convinced: could it be serious?
He replies Mauro Pepidirector of inter-departmental clinical and scientific projects, Monzino Cardiology Center, Milan (GO TO THE FORUM)
The presence of slight echo-free pericardial space on echo (“disconnection” is a term we use, but it is imprecise since the two pericardial sheets are only slightly apart) it is frequently physiological (a small amount of pericardial fluid or epicardial fat in some segments is visible echocardiographically in normal subjects, since it is a physiological lubricant between the two layers of the pericardium) and therefore, in the majority of cases, it is not related to a pathology (inflammation) of the pericardium (pericarditis). This physiological image, however, can be interpreted as pathological and can improperly generate the choice to use anti-inflammatories. Obviously, in this case, the control tests will only confirm the stable presence of this small physiological echo-free space over time.
A complex structure
In any case, a minimal echo-free space at the pericardial level during the echocardiographic examination should not cause concern does not cause functional heart problems, being physiological in most cases. The diagnosis is due to greater accuracy (image resolution) of echocardiographic devices, which allows in many healthy subjects to visualize small spaces (a few millimetres) between the two sheets of the pericardium (the one attached to the heart and the one that envelops it) which in the past were displayed as a single entity. The pericardium is in fact a complex structure: the serous pericardium consisting of two sheets, an external one that covers the internal surface of the fibrous pericardium and an internal one, also called epicardiumwhich adheres tightly to the surface of the heart, fusing with the interstitial tissue of the myocardium.
Post-Covid pericarditis
The echocardiographic examination therefore identifies in many subjects the space between the two sheets it contains minimal quantities of physiological fluid (up to 50 cc) and/or grease. The image, since both the liquid and the fat are anechoic (they do not reflect a return echo), is that of the two sheets which are highly echogenic, spaced apart from each other. In other cases, more significant payments (a space identified on echo in all segments of the heart and of significant size) deserve greater attention because they can be an expression of various pathologies (inflammatory, autoimmune or endocrinological, for example hypothyroidism). As regards the Post-Covid pericarditis, are extremely rare and the tests you perform may not be sufficient to make the diagnosis with certainty, which is not always simple. The temporal distance between Covid and inflammation of the pericardium must in fact be correlated to signs and symptoms of clinically certain pericarditis.
Symptoms to watch for
Chest pain typical for pericarditis and rubs on auscultation, fever, Ecg changes and marked increase in inflammatory indices they are useful/indispensable for the diagnosis (regardless of whether it is related to Covid or not). The doctors will certainly have based themselves on these clinical and instrumental aspects, knowing any other clinical problems (in particular thyroid problems or inflammatory diseases). In conclusion, her doctor correctly reassured her and the echocardiographic examination does not require further investigation in the absence of symptoms.
#pericardial #detachment #considered #symptoms #consequences