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Pericarditis


What is pericarditis?

Pericarditis is inflammation of the pericardium. The pericardium is a thin, protective, bag-like membrane surrounding the heart. It has two layers, with a lubricating fluid between the layers. Normally the layers can move against each other without irritation. An inflamed pericardium, however, causes irritation, swelling and pain.

Most cases of pericarditis are mild and get better on their own in a few days or weeks. More serious cases may be treated with medication. Early diagnosis and treatment of pericarditis can help to prevent complications.

Types of pericarditis

The different types of pericarditis can come on suddenly and last for a shorter time (acute) or develop and last over a longer time (chronic).

  • Acute fibrinous pericarditis occurs when the inflamed pericardium is covered with a layer of material called fibrin.
  • Acute purulent pericarditis occurs when the pericardium is infected and covered with a thick pus.
  • Acute constrictive pericarditis occurs when the pericardium is covered with a dense mass of calcified fibrosis material.
  • Chronic pericarditis lasts longer than three months. It can be caused by a long-term infection such as tuberculosis. It can lead to fluid build-up around the heart (pericardial effusion).
  • Dressler’s syndrome is a delayed form of pericarditis that is triggered by the immune system’s response to injury. It can happen weeks after a heart attack, heart surgery or a traumatic injury to the heart.
Causes

Pericarditis may be caused by:

  • bacterial, viral or fungal infection
  • rheumatic fever
  • rheumatoid arthritis
  • systemic lupus erythematous
  • kidney failure
  • scleroderma
  • tumours
  • heart attack
  • heart surgery
  • serious chest injury
  • certain medications that suppress the immune system
Symptoms

The most common symptom of pericarditis is chest pain. People describe it as sharp, stabbing or severe, and sometimes as aching and overwhelming. It usually occurs on the left side of the chest and can radiate to the left shoulder and neck.
 
Other symptoms may include:

  • increased pain as you breathe in
  • increased pain when you lie down
  • heart palpitations
  • difficulty breathing
  • flu-like symptoms – fever, fatigue, weakness
  • cough
  • abdominal swelling
  • leg swelling

Seek medical care immediately if you have chest pain that is new, worsening or constant.

Diagnosis

Your doctor will diagnose pericarditis after reviewing your symptoms, taking a medical history and giving you a complete physical exam. If you have pericarditis, your doctor may hear a pericardial rub – a scratchy or grating noise – through a stethoscope. The sound is often limited to just a small area of the heart, but it can change position and feel better if you lean forward and hold your breath.
 
Tests for pericarditis may include:

Treatment

The goals of pericarditis treatment are to:

  • decrease pain and inflammation
  • identify and treat the underlying cause of the condition
  • prevent complications

Treatment will include rest. Mild cases will get better on their own without any more treatment.
 
If you have a more serious case of pericarditis you may be prescribed medication:

  • non-prescription pain relievers
  • anti-inflammatories

If you don’t respond to pain relievers or anti-inflammatories, you may be prescribed a steroid.

 Complications

 

Often pericarditis will go away on its own in a period of days to weeks or even months. If it is left untreated however, it can cause complications.

  • Constrictive pericarditis is caused by permanent thickening and scarring of the pericardium. In this condition, the pericardium is rigid and unable to stretch with the heart as it pumps. The heart isn’t able to work effectively, which causes symptoms such as shortness of breath and severe swelling in the legs and /or abdomen.
  • Cardiac tamponade is caused by excess fluid accumulation in the pericardium (pericardial effusion). The extra fluid puts physical pressure on the heart, so the heart is unable to fill properly and less blood is pumped to the rest of the body. Blood pressure then drops significantly and this can lead to death if not treated.

Pericarditis doesn’t make you more likely to develop other types of coronary heart disease in the future.

Recovery

Although pericarditis doesn’t increase your risk for other types of coronary heart disease, it is still important control your blood pressure, diabetes and blood cholesterol, and lead a healthy lifestyle.

Talk to your doctor about the lifestyle changes that will benefit you the most.