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Pericarditis

What is pericarditis?

Pericarditis is inflammation of the pericardium, the thin sac (membrane) that surrounds the heart.

The pericardium holds the heart in place and helps it work properly. There is a small amount of fluid between the inner and outer layers of the pericardium. This fluid keeps the layers from rubbing as the heart moves to pump blood.

What causes pericarditis?

Usually, the cause of pericarditis is unknown, but may include any or all of the following: 

  • Infection (by viruses, bacteria, a fungus, or parasites)
  • Autoimmune disorders (such as systemic lupus erythematosus, rheumatoid arthritis, or scleroderma)
  • Inflammation after a heart attack
  • Chest  injury
  • Cancer
  • HIV/AIDS
  • Tuberculosis (TB)
  • Kidney failure
  • Medical treatments (such as certain medications or radiation therapy to the chest)
  • Heart surgery

What are the symptoms of pericarditis?

The following are the most common signs of pericarditis. However, each person may experience symptoms differently. Symptoms may include:

  • Chest pain that:
    • Can especially be felt behind the breastbone, and sometimes beneath the clavicle (collarbone), neck, and left shoulder.
    • Is a sharp, piercing pain over the center or left side of the chest that gets worse if the person takes a deep breath and usually gets better if the person sits up or leans forward.
    • Feels a lot like a heart attack.
  • Fever
  • Weakness and tiredness
  • Coughing
  • Trouble breathing
  • Pain when swallowing
  • Palpitations (irregular heartbeats)

The symptoms of pericarditis may resemble other conditions or medical problems. See a health care provider for a diagnosis.

How is pericarditis diagnosed?

If your health care provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub -- the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may be heard, too.

Along with a complete medical history and physical exam, tests used to diagnose pericarditis may include:

  • Echocardiogram (echo). This test uses sound waves to check your heart's size and shape. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin over the heart. Echo can show how well your heart is working and whether fluid has built up around your heart.
  • Electrocardiogram (ECG). This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.
  • Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
  • Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to look for thickening or other changes in the pericardium.
  • Cardiac CT. This type of X-ray takes a clear, detailed picture of your heart and pericardium. It may be used to help rule out other causes of chest pain.
  • Blood tests. Certain blood tests can help rule out other heart problems, such as heart attack, and can tell the doctor how much inflammation there is in your pericardium.

 

How is pericarditis treated?

Specific treatment for pericarditis will be determined by your health care provider based on the following:

  • The extent of the problem
  • Your age, overall health, and medical history
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disorder
  • The opinion of the health care providers involved in your care
  • Your opinion and preference

The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medications, such as pain medicines, anti-inflammatory drugs, and/or antibiotics.

If serious heart problems develop, treatment may include:

  • Aspiration or removal of excess fluid around the heart
  • Surgery

Pericarditis may last from 2 to 6 weeks, and it may come back.

What are the complications of pericarditis?

There is a small amount of fluid between the inner and outer layers of the pericardium. Often, when the pericardium becomes inflamed, the amount of fluid between these two layers increases. This is called a pericardial effusion. If the amount of fluid increases quickly, the effusion can keep the heart from working properly. This complication of pericarditis is called cardiac tamponade and is a serious emergency. A thin needle or tube (called a catheter) is put into the chest to remove the fluid in the pericardium and relieve pressure on the heart.

Chronic constrictive pericarditis occurs when scar-like tissue forms throughout the pericardium. It’s a rare disease that can develop over time in people with pericarditis. The scar tissue causes pericardial sac to stiffen and not move properly. In time, the scar tissue squeezes the heart and keeps it from working well. The only way to treat this is to remove the pericardium.

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, call your health care provider.

Key points

  • Pericarditis is inflammation of the pericardium, the thin sac that surrounds the heart.
  • Pericarditis may be caused by infection , autoimmune disorders, inflammation after a heart attack, chest injury, cancer, HIV/AIDS, tuberculosis (TB), kidney failure, medical treatments (such as certain medications or radiation therapy to the chest), and/or heart surgery.
  • The most common signs of pericarditis include chest pain, fever, weakness and tiredness, coughing, trouble breathing, pain when swallowing, and/or palpitations (irregular heartbeats).
  • If pericarditis is suspected, the health care provider will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub -- the sound of the pericardium rubbing against the outer layer of your heart.
  • The goal of treatment for pericarditis is to determine and eliminate the cause of the disease. Treatment often involves medications, such as pain medicines, anti-inflammatory drugs, and/or antibiotics. If serious heart problems develop, treatment may include removal of excess fluid around the heart or surgery.
  • Pericarditis may last from 2 to 6 weeks, and it may come back.
  • Pericarditis can lead to complications such pericardial effusion (a buildup of fluid around the heart that can keep it from working properly) and chronic constrictive pericarditis (scar-like tissue forms throughout the pericardium which squeezes the heart and keeps it from working well).

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
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