Pericarditis (patient information)

Pericarditis
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Pericarditis?
What to expect (Outlook/Prognosis)?
Possible complications
Prevention
Pericarditis On the Web
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Directions to Hospitals Treating Pericarditis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prashant Sharma

Overview

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

What are the symptoms of Pericarditis?

• Chest pain is almost always present, which is caused by the inflamed pericardium rubbing against the heart. 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. Patient may often feel better sitting up and leaning forward.
• Can be a sharp, stabbing pleuritic type pain (Pleuritis).

• Fever, chills, or sweating if the condition is caused by an infection.
• Ankle, feet, and leg swelling (occasionally if there is a constriction of the heart filling in a condition known as constrictive pericarditis).
• Anxiety
• Breathing difficulty when lying down (Orthopnea)
• Dry cough
• Fatigue

What causes Pericarditis?

The cause of pericarditis is often unknown or unproven, but is often the result of an infection such as:

• Viral infections that cause a chest cold or pneumonia, such as the echovirus or coxsackie virus (which are common in children), as well as influenza
• Infections with bacteria (much less common)
• Some fungal infections (even more rare)

In addition, pericarditis 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 medications, 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

Who is at highest risk?

Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections.

When to seek urgent medical care?

Pericarditis can be potentially life threatening and one should seek medical care when suffering from symptoms of pericarditis. Severe chest pain, fainting, palpitations and high grade fever may be ominous signs and may indicate build up of fluids within the pericardium, a condition called cardiac tamponade where the heart cannot expand to accept blood.

Diagnosis

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 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 (pleural effusion)

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 health care 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 options

Medications to treat pericarditis may include:

• Analgesics for pain
• Antibiotics for bacterial pericarditis
• Antifungal medications for fungal pericarditis
• Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
• Corticosteroids such as prednisone
• Colchicine
• Diuretics to remove excess fluid in the pericardial sac

If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it may be necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or minor surgery.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended as part of a procedure called pericardiectomy.

Where to find medical care for Pericarditis?

Directions to Hospitals Treating Pericarditis

What to expect (Outlook/Prognosis)?

Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

Possible complications

• Pericardial effusion or accumulation of fluid around the heart.
• Cardiac tamponade or compression of fluid on the heart that prevents the heart from filling normally.
• Constrictive pericarditis which is scarring of the sack around the heart that prevents the heart from filling normally.

Prevention

Many cases are not preventable.

Videos

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Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm Template:WH Template:WS