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Pericarditis

 

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

Causes

The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to 50 years.

Pericarditis is often the result of an infection such as:

  • Viral infections that cause a chest cold or pneumonia
  • Infections with bacteria (less common)
  • Some fungal infections (rare)

The condition may be seen with diseases such as:

  • Cancer (including leukemia)
  • Disorders in which the immune system attacks healthy body tissue by mistake
  • HIV infection and AIDS
  • Underactive thyroid gland
  • Kidney failure
  • Rheumatic fever
  • Tuberculosis (TB)

Other causes include:

  • Heart attack
  • Heart surgery or trauma to the chest, esophagus, or heart
  • Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system
  • Swelling or inflammation of the heart muscle
  • Radiation therapy to the chest

Symptoms

 

Chest pain is almost always present. The pain:

  • May be felt in the neck, shoulder, back, or abdomen
  • Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
  • Can feel sharp and stabbing
  • Is often relieved by sitting up and leaning or bending forward

You may have fever, chills, or sweating if the condition is caused by an infection.

Other symptoms may include:

  • Ankle, feet, and leg swelling
  • Anxiety
  • Breathing difficulty when lying down
  • Dry cough
  • Fatigue

 

Exams and Tests

 

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of excess fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

  • Crackles in the lungs
  • Decreased breath sounds
  • Other signs of fluid in the space around the lungs

The following imaging tests may be done to check the heart and the tissue layer around it (pericardium):

  • Chest MRI scan
  • Chest x-ray
  • Echocardiogram
  • Electrocardiogram
  • Heart MRI or heart CT scan
  • Radionuclide scanning

To look for heart muscle damage, the provider may order a troponin I test. Other laboratory tests may include:

  • Antinuclear antibody (ANA)
  • Blood culture
  • CBC
  • C-reactive protein
  • Erythrocyte sedimentation rate ( ESR )
  • HIV test
  • Rheumatoid factor
  • Tuberculin skin test

 

Treatment

 

The cause of pericarditis should be identified, if possible.

High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often given with a medicine called colchicine. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart.

If the cause of pericarditis is an infection:

  • Antibiotics will be used for bacterial infections
  • Antifungal medicines will be used for fungal pericarditis

Other medicines that may be used are:

  • Corticosteroids such as prednisone (in some people)
  • "Water pills" (diuretics) to remove excess fluid

If the buildup of fluid makes the heart function poorly, treatment may include:

  • Draining the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle.
  • Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity

Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.

 

Outlook (Prognosis)

 

Pericarditis can range from mild illness that gets better on its own, to a life-threatening condition. Fluid buildup around the heart and poor heart function can complicate the disorder.

The outcome is good if pericarditis is treated right away. Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic, if symptoms or episodes continue.

Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe. This is called constrictive pericarditis . It can cause long-term problems similar to those of heart failure.

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of pericarditis. This disorder is not life threatening most of the time. However, it can be very dangerous if not treated.

 

Prevention

 

Many cases cannot be prevented.

 

 

Open References

References

Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA . 2015; 314(14):1498-1506. PMID: 26461998 www.ncbi.nlm.nih.gov/pubmed/26461998 .

LeWinter MM, Hopkins WE. Pericardial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 71.

 
  • Pericardium

    Pericardium - illustration

    The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

    Pericardium

    illustration

  • Pericarditis

    Pericarditis - illustration

    Pericarditis is a disorder caused by inflammation of the pericardium, the sac-like covering of the heart. Pericarditis can be caused by bacterial, fungal, or viral infections. It may also be a result of injury or trauma to the chest, esophagus, or heart. Pain occurs as a result of the inflamed pericardium rubbing against the heart.

    Pericarditis

    illustration

    • Pericardium

      Pericardium - illustration

      The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

      Pericardium

      illustration

    • Pericarditis

      Pericarditis - illustration

      Pericarditis is a disorder caused by inflammation of the pericardium, the sac-like covering of the heart. Pericarditis can be caused by bacterial, fungal, or viral infections. It may also be a result of injury or trauma to the chest, esophagus, or heart. Pain occurs as a result of the inflamed pericardium rubbing against the heart.

      Pericarditis

      illustration

    Tests for Pericarditis

     
       

      Review Date: 2/24/2016

      Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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