Pericardial Disease (Pericarditis)
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.
Pericarditis Symptoms and Diagnosis
When the pericardium is inflamed, it becomes swollen and irritated. Acute pericarditis usually lasts for a few days. Infrequently, pericarditis is chronic, and may last for months.
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, and may get worse if you take a deep breath, cough 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
- Younger age: most cases of pericarditis occur between the ages of 20 and 50.
- Pericarditis is more common in men than women.
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. Identifying the cause can help determine treatment. If a cause can’t be found, the condition is known as idiopathic pericarditis.
To diagnose pericarditis, your doctor can listen to your heart, specifically for a rubbing or creaking sound known as "pericardial rub," which is produced by the inflamed layers of the pericardium rubbing against each other.
If pericarditis is suspected, you may undergo several tests to determine whether you have suffered a heart attack, if fluid has collected in the pericardial sac, or whether there are signs of inflammation. Tests may include:
- Electrocardiogram (EKG or ECG)
- Chest X-ray
- CT scan
- Cardiac MRI
- Blood tests
- Cardiac catheterization
Pericarditis Treatment at BIDMC
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. 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:
- Medication to reduce inflammation, pain and swelling
- Cardiac tamponade: dangerous levels of fluid can build up around the heart, possibly requiring a pericardiocentesis, a procedure to drain the excess fluid from the pericardial sac.
- Constrictive pericarditis: inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together; this constricts the heart from expanding when filling with blood. If the blood backs up behind the heart, heart failure can result. Some cases may be treated with surgery to remove the stiffened pericardium.