Pericardial Disease (Pericarditis)
Inflammation of the Pericardium
Pericarditis is an inflammation of the pericardium, the thin, double-layered, fluid-filled sac that covers the outer surface of your heart. The pericardium is designed to shield your heart from infection, as well as to keep the heart from expanding too much when blood volume rises. When the pericardium is inflamed, it becomes swollen and irritated.
Acute vs. Chronic
Acute pericarditis usually lasts anywhere from a few days to three or four. Infrequently, pericarditis is chronic, and may last for months.
Signs and Symptoms
The most common symptom of pericarditis is sharp, stabbing chest pain beneath the breastbone or in the left side of your chest. The pain may move into your left shoulder and neck. It may be exacerbated by a deep breath, coughing or lying down. Sitting forward occasionally relieves the pain. Other symptoms may include:
- Shortness of breath
- Overall weakness and fatigue
- Swollen ankles and feet
- Dry cough
- Most cases of pericarditis occur in younger people, between the ages of 20 and 50.
- Pericarditis is more common in men than women.
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Causes of Pericarditis
Pericarditis may be associated with:
- Viral infections (influenza, common cold)
- Autoimmune disorders
- Recent heart attack
- Recent heart surgery
- Thyroid disease
- Kidney failure
- Tuberculosis (TB)
- Certain medications
A specific cause of pericarditis is found in only 20 to 30 percent of cases. Treatment can depend on the causes, so it is important to identify the cause if possible. When the cause cannot be determined, the condition is known as idiopathic pericarditis.
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Your doctor will start by taking your medical history and asking questions about your symptoms. The doctor will also perform a physical exam and check your heart sounds using a stethoscope, listening for a rubbing or creaking sound known as "pericardial rub." The sound is produced by the inflamed layers of the pericardium rubbing against each other.
Your doctor may also schedule you to undergo any number of tests to determine such things as whether you have suffered a heart attack, if fluid has collected in the pericardial sac or whether there are signs of inflammation. These tests may include:
Electrocardiogram (EKG or ECG)
This is a painless, noninvasive test in which patches with electrodes are attached to your skin to measure electrical impulses produced by your heart. These impulses are recorded as waves displayed on a monitor or printed out on graph paper. The EKG also shows how fast your heart is beating and its rhythm (steady or irregular). Certain results may indicate pericarditis.
This test uses sound waves to create a moving picture of your heart.
- Provides information about the size and shape of your heart and how well your heart chambers and valves are functioning.
- Identifies areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.
- Echocardiograms can also show fluid accumulation in the pericardium.
The test is performed by placing a probe on your chest wall. It is the same technique used in sonograms in pregnant women.
Images show the size and shape of your heart and may reveal an enlarged heart if fluid has accumulated in the pericardium.
A computerized tomography scan can show more detailed images of your heart and the pericardium than a conventional X-ray. It can also show fluid accumulation, signs of inflammation or scarring of the pericardium.
A magnetic resonance imaging scan is a noninvasive test that uses a strong magnetic field to produce images of your heart and does not use any radiation. An MRI scan can show fluid in the pericardium and inflammation of the pericardial layers. Please inform your doctor about any metal that may be present in your body, such as clips from prior surgery, foreign body from trauma or other.
Such tests can determine if you are having a heart attack and can test the fluid in the pericardium to try and find out the cause of pericarditis.
Cardiac catheterization is an invasive test that involves injecting a dye into your arteries in what is called an angiogram. The dye is delivered through a long, thin, flexible tube called a catheter that is threaded through a leg artery into the coronary arteries.
This procedure is rarely needed to diagnose pericarditis, although it may occasionally be necessary to exclude other causes for your chest pain, such as a heart attack.
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In the vast majority of pericarditis cases, symptoms tend to go away after several days. However, further treatment may be necessary depending on the cause of pericarditis. Rarely, severe cases of pericarditis may be life-threatening.
Most people recover in days to weeks if pericarditis is treated promptly, though the condition can come back. Treatments may include:
Rest & Medications
You may be told to rest or stay in bed until you are better. At the same time, you may be prescribed one or more of a number of medications to reduce inflammation, pain and swelling, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
- Colchicine, another anti-inflammatory medication
- Corticosteroids such as prednisone
- Antibiotics if caused by bacterial infection
- Antifungal medication if caused by fungal infection
- Diuretics to remove excess fluid from the pericardial sac
A serious complication of pericarditis is cardiac tamponade — when dangerous levels of fluid build up around the heart, which may require a medical procedure called pericardiocentesis. In this procedure, your doctor uses a sterile needle or catheter to drain the excess fluid from the pericardial sac.
This is a severe form of chronic pericarditis where inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. As a result, the heart's normal movement is constricted so that it cannot expand normally while filling with blood. If the blood backs up behind the heart, heart failure can result.
While constrictive pericarditis can often be treated with diuretic drugs, sometimes it requires surgery known as a pericardiectomy or pericardial stripping, where the stiffened pericardium is removed.
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