Pericarditis (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D.; Prashant Sharma

What is pericarditis?

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

What are the symptoms of pericarditis?

• Chest pain, caused by the inflamed pericardium rubbing against the heart.

May radiate to the neck, shoulder, back, or abdomen. Often increases with deep breathing and lying flat, and may increase with coughing and swallowing. Pleuritis type: a sharp, stabbing pain. Usually relieved by sitting up and leaning forward.

• Fever
• Ankle, feet, and leg swelling (occasionally).
• Anxiety
• Breathing difficulty when lying down.
• Dry cough
• Fatigue
• Need to bend over or hold the chest while breathing.

What causes Pericarditis?

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection.

Infections with bacteria can lead to bacterial pericarditis (also called purulent(pus) pericarditis). Some fungal infections can also produce pericarditis.

In addition, pericarditis can be associated with diseases such as:

• Autoimmune disorders
• Cancer (including leukemia)
• HIV infection and AIDS
• Hypothyroidism
• Kidney failure
• Rheumatic fever
• Tuberculosis

Other causes include:

Heart attack (see post-MI pericarditis) Injury (including surgery) or trauma to the chest, esophagus(food pipe), or heart Medications that suppress the immune system Myocarditis Radiation therapy to the chest Often the cause of pericarditis remains unknown. In this case, the condition is called idiopathic(unknown cause) pericarditis.

Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections. In children, it is most commonly caused by adenovirus or coxsackie virus.

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 maybe ominous signs and may indicate build up of fluids within the pericardium, called cardiac tamponade.

Treatment options

The cause of pericarditis must be identified, if possible, for this the physician may decide to do the following:

• Chest MRI scan
• Chest x-ray
• ECG
• Echocardiogram
• Heart MRI or heart CT scan
• Radionuclide scanning

Medications 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 is 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.

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

• Arrhythmias
• Cardiac tamponade
• Constrictive pericarditis, which may develop into heart failure.

Sources

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

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