Pericarditis (patient information)
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Pericarditis |
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Pericarditis On the Web |
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For the WikiDoc page on Pericarditis, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.
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. Patients 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 signs of a build up of fluids within the pericardium, which is referred to as a cardiac tamponade. A cardiac tamponade is a condition in which 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 layer of tissue that surrounds 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
The cause of pericarditis must be identified, if possible.
High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often given. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart.
A medicine called colchicine may be added, especially if pericarditis does not go away after 1 to 2 weeks or it comes back weeks or months later.
If the cause of pericarditis is an infection:
- Antibiotics will be used for bacterial infections
- Antifungal medications will be used for fungal pericarditis
Other medications that may be used are:
- Corticosteroids such as prednisone (in some patients)
- "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.
If the pericarditis is chronic, recurrent, or causes scarring or tightening of the tissue around the heart, cutting or removing part of the pericardium may be needed. This surgery is called a 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 fluid buildup around the heart and poor heart function.
The outcome is good if the disorder 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 of the heart muscle may occur in severe cases. This is called constrictive pericarditis, and it can cause long-term problems similar to those of heart failure.
Possible complications
- Pericardial effusion or accumulation of fluid around the heart.
- Cardiac tamponade or compression on the heart by the fluid that prevents the heart from filling normally.
- Constrictive pericarditis which is scarring of the sac around the heart that prevents the heart from filling normally.
Prevention
Many cases are not preventable.
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Sources
http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm Template:WH Template:WS