Pericarditis

What is Pericarditis

Pericarditis is inflammation of the pericardium. The pericardium is a thin, double-layered, fluid-filled sac that surrounds your heart. The pericardium protects and holds your heart in your chest cavity.

Inflammation of your pericardium can cause rubbing (friction) between the two layers when your heart beats. Fluid may also build up between the layers of the sac (pericardial effusion).

6 Interesting Facts of Pericarditis

  1. Acute or chronic inflammation of the pericardium, most commonly caused by a virus
    • Other causes include nonviral infections, autoimmune diseases, uremia, previous myocardial infarction, cardiac surgery, malignancies, radiation, medications, and trauma
  2. Presentation may be similar to myocarditis with difficulty breathing, chest pain, and diminished cardiac output secondary to pericardial effusion and tamponade 
  3. Characteristic chest pain associated with pericarditis may help differentiate conditions; chest pain exacerbated by cough, inspiration, and supine positioning that improves with leaning forward suggests pericarditis 
  4. Presence of a pericardial friction rub is pathognomonic for pericarditis but not universally appreciable on examination; presence of pulsus paradoxus suggests tamponade or constrictive pericarditis; Beck triad (ie, hypotension, increased jugular venous pressure, muffled heart sounds) suggests tamponade physiology 
  5. Acute pericarditis may be diagnosed with 2 of 4 manifestations: chest pain, pericardial friction rub, characteristic ECG findings (diffuse ST elevation and PR depression), and pericardial effusion on echocardiogram
  6. Cardiac MRI may be required to differentiate the 2 conditions if diagnosis remains uncertain

There are three types of this condition:

  • Acute pericarditis. Inflammation develops suddenly and causes pericardial effusion.
  • Chronic pericarditis. Inflammation may develop slowly, or it may continue after acute pericarditis and last longer than 6 months.
  • Constrictive pericarditis (rare). The layers of the pericardium stiffen and develop scar tissue. The scar tissue thickens and sticks together. This makes it difficult for the heart to work in a normal way.

In most cases, pericarditis is acute and not serious. Chronic pericarditis and constrictive pericarditis are more serious and may require treatment.

What are the causes?

In most cases, the cause of this condition is not known. If a cause is found, it may be:

  • An infection from a virus.
  • A heart attack (myocardial infarction).
  • Problems after open-heart surgery.
  • Chest injury.
  • Autoimmune disorder. The body’s defense system (immune system) attacks healthy tissues. Examples include lupus or rheumatoid arthritis.
  • Kidney failure.
  • Underactive thyroid gland (hypothyroidism).
  • Cancer that has spread (metastasized) to the pericardium from another part of the body.
  • Treatment using high-energy X-rays (radiation).
  • Certain medicines, including some seizure medicines, blood thinners, heart medicines, and antibiotics.
  • Infection from a fungus or bacteria (rare).

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Being male.
  • Being 20–50 years old.
  • Having had pericarditis before.
  • Having had a recent upper respiratory tract infection.

What are the signs or symptoms?

The main symptom of this condition is chest pain. The chest pain may:

  • Be in the center or the left side of your chest.
  • Not go away with rest.
  • Last for many hours or days.
  • Worsen when you lie down and get better when you sit up and lean forward.
  • Worsen when you swallow.
  • Move to your back, neck, or shoulder.

Other symptoms may include:

  • A chronic, dry cough.
  • Heart palpitations. These may feel like rapid, fluttering, or pounding heartbeats.
  • Dizziness or fainting.
  • Tiredness or fatigue.
  • Fever.
  • Rapid breathing.
  • Shortness of breath when lying down.

How is this diagnosed?

This condition is diagnosed based on medical history, physical exam, and diagnostic tests. During your physical exam, your health care provider will listen for friction while your heart beats (pericardial rub). You may also have tests, including:

  • Blood tests to look for signs of infection and inflammation.
  • Electrocardiogram (ECG). This test measures the electrical activity in your heart.
  • Echocardiogram. This uses sound waves to make images of your heart.
  • CT scan.
  • MRI.
  • Culture of pericardial fluid.
  • Removing a tissue sample of the pericardium to look at under a microscope (biopsy).

If tests show that you may have constrictive pericarditis, a small, thin tube may be inserted into your heart to confirm the diagnosis (cardiac catheterization).

How is this treated?

Treatment for this condition depends on the cause and type of pericarditis that you have. In most cases, acute pericarditis will clear up on its own. Treatment may include:

  • Limiting physical activity.
  • Medicines, such as:
    • NSAIDs to relieve pain and inflammation.
    • Steroids to reduce inflammation.
    • Colchicine to relieve pain and inflammation.
  • A procedure to remove fluid using a needle (pericardiocentesis) if fluid buildup puts pressure on the heart.
  • Surgery to remove part of the pericardium if constrictive pericarditis develops.

If another condition is causing your pericarditis, you may also need treatment for that condition.

Follow these instructions at home:

  • Limit your activity as told by your health care provider until your symptoms improve. This usually includes:
    • Resting or sitting for most of the day.
    • No long walks.
    • No exercise.
    • No sports.
  • Athletes may need to limit competition for several months.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Eat a heart-healthy diet. Ask your dietitian what foods are healthy for your heart.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
    • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You continue to have symptoms of pericarditis.
  • You develop new symptoms of pericarditis.
  • Your symptoms get worse.
  • You have a fever.

Get help right away if:

  • You have worsening chest pain. 
  • You have difficulty breathing.
  • You pass out.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Pericarditis is inflammation of the pericardium.
  • The pericardium is a thin, double-layered, fluid-filled sac that surrounds your heart.
  • The main symptom of this condition is chest pain.
  • Treatment for this condition depends on the cause and type of pericarditis that you have.
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