Pericarditis

What is Pericarditis?

Pericarditis is inflammation of the membranous sac (pericardium) that surrounds the heart. The pericardium holds the heart in place and helps it work properly. The sac is made of two thin layers of tissue that enclose your heart. Between the two layers is a small amount of fluid. This fluid keeps the layers from rubbing against each other and causing friction. Pericarditis typically causes sharp chest pain & fever. The chest pain from pericarditis may feel like pain from a heart attack. Pericarditis can be acute or chronic. "Acute" means that it occurs suddenly and usually doesn’t last long. "Chronic" means that it develops over time and may take longer to treat.

  • It is more common in males 30-50 years old.
  • Most cases are due to a viral infection & the condition usually resolves within a few weeks.
  • Pericarditis is not a life-threatening condition.

Causes of Pericarditis

The cause of about 50% of all pericarditis cases (both acute and chronic) is unknown (idiopathic). Viral infections are likely the most common cause of acute pericarditis. Several different viruses can cause pericarditis including coxsackie virus, adenoviruses, and the mumps virus but often the virus may never be found. Pericarditis often occurs after a respiratory infection.

Less often, pericarditis is caused by:

  • Autoimmune disorders, such as lupus, scleroderma, and rheumatoid arthritis
  • Heart attack (Dressler syndrome) and heart surgery
  • Kidney failure, HIV/AIDS, cancer, tuberculosis
  • Injury from accidents or radiation therapy
  • Certain medicines, like phenytoin (an antiseizure medicine), warfarin and heparin (blood-thinning medicines), and procainamide (a medicine to treat abnormal heartbeats)

In idiopathic pericarditis, no clear cause is found.

Symptoms of Pericarditis

A Sharp, stabbing chest pain that comes on quickly is a common symptom of acute pericarditis. The chest pain from pericarditis may feel like pain from a heart attack. The pain often is felt in the middle (behind the breast bone) or the left side of the chest. Sometimes the pain may spread to the neck & shoulders.

The pain tends to ease when you sit up and lean forward and it may get worse when you take a deep breath, cough, swallow, or lie down. For some people, the pain feels like a dull ache or pressure in their chests.

Fever is another common symptom of acute pericarditis. Other symptoms are weakness, trouble breathing, and coughing. Chronic pericarditis often causes tiredness, coughing, and shortness of breath. Chest pain is often absent in this type of pericarditis. Severe cases of chronic pericarditis can lead to swelling in the stomach and legs and low blood pressure (hypotension).

Diagnosis of Pericarditis

Your doctor will diagnose pericarditis based on your medical history and the results from a physical examination and tests as detailed below:

Medical History for pericarditis

Your doctor may ask whether you:

  • Have had a recent respiratory infection or flu-like illness
  • Have had a recent heart attack or injury to your chest
  • Have any other medical conditions

Your doctor also may ask about your symptoms. If you have chest pain, he or she will ask you to describe how it feels, where it’s located, and whether it’s worse when you lie down, breathe, or cough.

Physical Examination for pericarditis

When the pericardium (the sac around your heart) is inflamed, the amount of fluid between its two layers of tissue increases. As part of the exam, your doctor will look for signs of excess fluid in your chest. A common sign is the "pericardial rub". This is the sound of the pericardium rubbing against the outer layer of your heart. Your doctor will place a stethoscope on your chest to listen for this sound. Your doctor may hear other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion). These are more severe problems related to pericarditis.

Diagnostic Tests for pericarditis

Your doctor may order one or more tests to diagnose your condition and show how severe it is. The most common tests are:

  • ECG (electrocardiogram). This simple test detects and records the electrical activity of your heart. Certain ECG results suggest pericarditis.
  • Chest X-ray. A chest x-ray takes pictures of your heart and lungs. The images can show whether you have an enlarged heart. This is a sign of excess fluid in your pericardium.
  • Echocardiography. This painless test uses sound waves to create pictures of your heart. The pictures show the size and shape of your heart and how well your heart is working. This test can show whether fluid has built up in the pericardium.
  • Cardiac CT (computed tomography). This is a type of x ray that takes a clear, detailed picture of your heart and pericardium. CT helps rule out other causes of chest pain.
  • Cardiac MRI (magnetic resonance imaging). This test uses powerful magnets and radio waves to create detailed pictures of your organs and tissues. MRI can show changes in the pericardium.

Your doctor also may order blood tests. These tests can help your doctor find out whether you’ve had a heart attack, the cause of the pericarditis, and how inflamed your pericardium is.

Who Is At Risk from Pericarditis?

Pericarditis occurs in people of all ages. However, men between the ages of 20 and 50 are more likely to get it. People who are treated for acute pericarditis may get it again. This may happen in 15 to 30 percent of people who have the condition. A small number of these people go on to develop chronic pericarditis.

Complications of Pericarditis

Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis.

Cardiac tamponade occurs when too much fluid collects in the pericardium (the sac around the heart). The extra fluid puts pressure on the heart. This prevents the heart from properly filling with blood. As a result, less blood leaves the heart. This causes a sharp drop in blood pressure. If left untreated, cardiac tamponade can cause death.

Chronic constrictive pericarditis is a rare disease that develops over time. It leads to scar-like tissue throughout the pericardium. The sac becomes stiff and can’t move properly. In time, the scarred tissue compresses the heart and prevents it from working correctly.

Treatment of Pericarditis

Most cases of pericarditis are mild and clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures and/or surgery.

The goals of treatment are to:

  • Reduce pain and inflammation
  • Treat the underlying cause, if it’s known
  • Check for complications

Specific Types of Treatment

As a first step in your treatment, your doctor may advise you to rest until you feel better and have no fever. He or she may tell you to take over-the-counter, anti-inflammatory medicines, such as aspirin or ibuprofen, to reduce pain and inflammation. You may need stronger medicine if your pain is severe.

If your pain continues to be severe, your doctor may prescribe a medicine called colchicine and, possibly, prednisone (a steroid medicine). If an infection is causing your pericarditis, your doctor will prescribe an antibiotic or other appropriate medicine to treat the infection.

You may need to stay in the hospital during treatment so your doctor can keep an eye on you for complications. The symptoms of acute pericarditis can last from a few days to 3 weeks. Chronic cases may last several months.

Other Types of Treatment for pericarditis

If you have complications of pericarditis, you’ll need treatment for those problems. Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis.

Cardiac tamponade is treated with a procedure called periocardiocentesis. A needle or tube (called a catheter) is inserted into the chest wall to remove excess fluid that has collected inside the pericardium. This relieves pressure on the heart.

If time allows, the fluid may be removed with a special catheter or tube put through a small cut in the chest.

The only cure for chronic constrictive pericarditis is surgery to remove the pericardium. This is known as a pericardiectomy.

The treatments for these complications require hospital stays.

How Can Pericarditis Be Prevented?

You usually can’t prevent acute pericarditis. But, you can take steps to reduce your chances of having another acute episode, having complications, or getting chronic pericarditis. These steps include getting prompt treatment, following your treatment plan, and having ongoing medical care (as your doctor advises).

Living With Pericarditis

Many cases of pericarditis are mild and clear up on their own. But other cases, if not treated, can lead to chronic pericarditis and serious problems that affect your heart. Some problems can be life threatening. In some cases, it may take weeks or months to recover from a case of pericarditis. Full recovery is likely with rest and ongoing care. These measures also can help reduce the chances of having the condition again.

Key Points to recap about pericarditis

  • Pericarditis is a condition in which the membrane, or sac, around your heart is inflamed. This sac is called the pericardium.
  • The pericardium holds the heart in place and helps it work properly. The sac is made of two thin layers of tissue that enclose your heart.
  • In pericarditis, the layers of tissue become inflamed and can rub against the heart, causing chest pain. The chest pain may feel like pain from a heart attack.
  • Many factors can cause pericarditis. Viruses and infections are common causes. Less often, pericarditis occurs after a heart attack or heart surgery. Lupus, scleroderma, rheumatoid arthritis, or other autoimmune disorders also can cause the condition. In about half of all cases, the cause is unknown.
  • Pericarditis can be acute or chronic. "Acute" means that it occurs suddenly and usually doesn’t last long. "Chronic" means that it develops over time and may take longer to treat.
  • Both acute and chronic pericarditis can disrupt your heart’s normal function and possibly (although rarely) lead to death.
  • Pericarditis occurs in people of all ages. However, men between the ages of 20 and 50 are more likely to get it.
  • Sharp, stabbing chest pain and fever are common symptoms of acute pericarditis. Other symptoms are weakness, trouble breathing, and coughing. Chronic pericarditis often causes tiredness, coughing, and shortness of breath. In severe cases, it can lead to swelling in the stomach and legs and low blood pressure.
  • Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis. These conditions can disrupt your heart’s normal function. If left untreated, they may lead to death.
  • Your doctor will diagnose pericarditis based on your medical history and the results from a physical exam and tests.
  • Most cases of pericarditis are mild and clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures and/or surgery.
  • You usually can’t prevent acute pericarditis. But, you can take steps to reduce your chances of having another acute episode, having complications, or getting chronic pericarditis. Get prompt treatment, follow your treatment plan, and get ongoing medical care (as your doctor advises).
  • In some cases, it may take weeks or months to recover from pericarditis. Full recovery is likely with rest and ongoing care. These measures also can help reduce the chances of having the condition again.

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