Pericarditis

Pericarditis is swelling (inflammation) of the pericardium. The pericardium is a thin, double-layered, fluid-filled tissue sac that surrounds the heart. The purpose of the pericardium is to contain the heart in the chest cavity and keep the heart from overexpanding. Different types of pericarditis can occur, such as:

  • Acute pericarditis. Inflammation can develop suddenly in acute pericarditis.

  • Chronic pericarditis. Inflammation develops gradually and is long-lasting in chronic pericarditis.

  • Constrictive pericarditis. In this type of pericarditis, the layers of the pericardium stiffen and develop scar tissue. The scar tissue thickens and sticks together. This makes it difficult for the heart to pump and work as it normally does.

CAUSES

Pericarditis can be caused from different conditions, such as:

  • A bacterial, fungal or viral infection.

  • After a heart attack (myocardial infarction).

  • After open-heart surgery (coronary bypass graft surgery).

  • Auto-immune conditions such as lupus, rheumatoid arthritis or scleroderma.

  • Kidney failure.

  • Low thyroid condition (hypothyroidism).

  • Cancer from another part of the body that has spread (metastasized) to the pericardium.

  • Chest injury or trauma.

  • After radiation treatment.

  • Certain medicines.

SYMPTOMS

Symptoms of pericarditis can include:

  • Chest pain. Chest pain symptoms may increase when laying down and may be relieved when sitting up and leaning forward.

  • A chronic, dry cough.

  • Heart palpitations. These may feel like rapid, fluttering or pounding heart beats.

  • Chest pain may be worse when swallowing.

  • Dizziness or fainting.

  • Tiredness, fatigue or lethargy.

  • Fever.

DIAGNOSIS

Pericarditis is diagnosed by the following:

  • A physical exam. A heart sound called a pericardial friction rub may be heard when your caregiver listens to your heart.

  • Blood work. Blood may be drawn to check for an infection and to look at your blood chemistry.

  • Electrocardiography. During electrocardiography your heart's electrical activity is monitored and recorded with a tracing on paper (electrocardiogram [ECG]).

  • Echocardiography.

  • Computed tomography (CT).

  • Magnetic resonance image (MRI).

TREATMENT

To treat pericarditis, it is important to know the cause of it. The cause of pericarditis determines the treatment.

  • If the cause of pericarditis is due to an infection, treatment is based on the type of infection. If an infection is suspected in the pericardial fluid, a procedure called a pericardial fluid culture and biopsy may be done. This takes a sample of the pericardial fluid. The sample is sent to a lab which runs tests on the pericardial fluid to check for an infection.

  • If the autoimmune disease is the cause, treatment of the autoimmune condition will help improve the pericarditis.

  • If the cause of pericarditis is not known, anti-inflammatory medicines may be used to help decrease the inflammation.

  • Surgery may be needed. The following are types of surgeries or procedures that may be done to treat pericarditis:

  • Pericardial window. A pericardial window makes a cut (incision) into the pericardial sac. This allows excess fluid in the pericardium to drain.

  • Pericardiocentesis. A pericardiocentesis is also known as a pericardial tap. This procedure uses a needle that is guided by X-ray to drain (aspirate) excess fluid from the pericardium.

  • Pericardiectomy. A pericardiectomy removes part or all of the pericardium.

HOME CARE INSTRUCTIONS

  • Do not smoke. If you smoke, quit. Your caregiver can help you quit smoking.

  • Maintain a healthy weight.

  • Follow an exercise program as told by your caregiver.

  • If you drink alcohol, do so in moderation.

  • Eat a heart healthy diet. A registered dietician can help you learn about healthy food choices.

  • Keep a list of all your medicines with you at all times. Include the name, dose, how often it is taken and how it is taken.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have chest pain or feelings of chest pressure.

  • You have sweating (diaphoresis) when at rest.

  • You have irregular heartbeats (palpitations).

  • You have rapid, racing heart beats.

  • You have unexplained fainting episodes.

  • You feel sick to your stomach (nausea) or vomiting without cause.

  • You have unexplained weakness.

If you develop any of the symptoms which originally made you seek care, call for local emergency medical help. Do not drive yourself to the hospital.