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List of All Topics
Pericarditis
Introduction
Pericarditis is a swelling and irritation of the pericardium, the thin sac-like membrane that surrounds your heart. Pericarditis often causes chest pain and sometimes other symptoms. Pericarditis may be acute or chronic. The sharp chest pain associated with acute pericarditis occurs when the pericardium rubs against the heart's outer layer.
Mild cases may improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications.
Signs and symptoms
If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity. The sharp pain may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.
Other signs and symptoms often associated with pericarditis include:
- Shortness of breath when reclining.
- Low-grade fever .
- An overall sense of weakness, fatigue or feeling sick.
- Dry cough.
- Abdominal or leg swelling.
Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis the sac becomes inflamed and the resulting friction from the inflamed sac rubbing against the outer layer of your heart leads to chest pain.
In some cases the amount of fluid contained in the pericardial sac may increase, causing what is called pericardial effusion.
The cause of pericarditis is often hard to determine. In most cases doctors are either unable to determine a cause (idiopathic) or suspect a viral infection.
Pericarditis can also develop shortly after a major heart attack due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery because of antibody formation. This delayed pericarditis is known as Dressler's syndrome. Many experts believe Dressler's syndrome is due to an autoimmune response, a mistaken inflammatory response by the body to its own tissues — in this case, the heart and pericardium.
Other causes of pericarditis include:
- Systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.
- Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
- Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.
- Certain medications. Some medications can cause pericarditis, although this is unusual.
Deciding upon treatment for pericarditis will likely involve consideration of the underlying cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment.
Rest and medications
Your doctor may recommend bed rest until you're feeling better. Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed. Most pain associated with pericarditis responds well to treatment with aspirin or another nonsteroidal anti-inflammatory drug (NSAID). If your pain is severe, you might need stronger pain medications, such as a narcotic, for a short time.
Acute episodes of pericarditis typically last from one to three weeks, but future episodes can occur. About one in five people with pericarditis has a recurrence within months of the original episode. People who have repeated episodes of pericarditis are often treated with a drug called colchicine, and sometimes steroid medications are used.
When a bacterial infection is the underlying cause of pericarditis, you'll be treated with antibiotics and drainage if necessary.
Hospitalization and procedures
You'll likely need hospitalization if your doctor suspects cardiac tamponade, a potentially dangerous complication of pericarditis. When cardiac tamponade is present, you may undergo a technique called pericardiocentesis. In some cases of severe pericarditis, your doctor might suggest surgically removing your pericardium (pericardiectomy).
- Pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram monitoring and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization.
- Pericardiectomy. If you're diagnosed with constrictive pericarditis, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is compromising the functioning of your heart.
Information obtained from National Institute of Health