Pericarditis

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

The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to 50.

Pericarditis is often the result of an infection such as:
  • Viral infections that cause a chest cold or pneumonia, such as echovirus or coxsackie virus (common in children) and influenza
  • Infections with bacteria 
  • Some fungal infections 
The condition may be seen with diseases such as:
  • Cancer 
  • Disorders in which the immune system attacks healthy body tissue by mistake
  • HIV infection and AIDS
  • Underactive thyroid gland
  • Kidney failure
  • Rheumatic fever
  • Tuberculosis
Other causes include:
  • Heart attack
  • Heart surgery or trauma to the chest, esophagus, or heart
  • Certain medicines used to treat cancer or suppress the immune system
  • Swelling or inflammation of the heart muscle
  • Radiation therapy to the chest

Chest pain is almost always present.

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
  • Can feel sharp and stabbing
  • Is often relieved by sitting up and leaning or bending forward

You may have fever, chills, or sweating if the condition is caused by an infection.

Other symptoms may include:
  • Ankle, feet, and leg swelling
  • Anxiety
  • Breathing difficulty when lying down
  • Dry cough
  • Fatigue

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

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 laboratory tests:

  • Antinuclear antibody
  • Blood culture
  • CBC
  • C-reactive protein
  • Erythrocyte sedimentation rate 
  • HIV test
  • Rheumatoid factor
  • Tuberculin skin test

The cause of pericarditis should 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.

If pericarditis does not go away after 1 to 2 weeks, or it comes back weeks or months later, a medicine called colchicine may be added.

If the cause of pericarditis is an infection:
  • Antibiotics will be used for bacterial infections
  • Antifungal medicines will be used for fungal pericarditis
Other medicines that may be used are:
  • Corticosteroids such as prednisone 
  • "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 in the pericardium to allow the infected fluid to drain into the abdominal cavity

Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.

Pericarditis can range from mild illness that gets better on its own, to a life-threatening condition. Fluid buildup around the heart and poor heart function can complicate the disorder.

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

Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe. This is called constrictive pericarditis. It can cause long-term problems similar to those of heart failure.