Pericarditis is a condition in which the sac-like membrane that surrounds the heart becomes irritated and inflamed. In most cases, the condition comes on suddenly and resolves within a few months. If left untreated, pericarditis can cause the pericardium to become rigid, leading to symptoms of heart failure.
Definition & Facts
The pericardium is a thin sac of tissue that encloses and protects the heart. It is composed of two layers separated by lubricating fluid. The inner layer, called the visceral pericardium, encases the entire cardiac muscle. The outermost layer, which is made of fibrous tissue, is the parietal pericardium. Between these two layers is a thin layer of fluid that prevents friction between the visceral and parietal pericardium.
Over time, pericarditis can cause the pericardial sac to become scarred and thickened, which can affect the ability of the heart to expand properly. Another potential complication of pericarditis is cardiac tamponade. This occurs when excess fluid collects in the pericardium so that the heart is unable to pump blood effectively. This can result in a fatal drop in blood pressure if it is not treated promptly. Pericarditis is a relatively rare condition in both adults and children.
Symptoms & Complaints
Many patients find that the pain is eased when they lean forward or sit up and that it is worse when taking a deep breath, lying down, or coughing. It is not unusual for individuals with pericarditis to confuse their symptoms for a heart attack. Other symptoms of pericarditis include:
- Shortness of breath.
- Low-grade fever.
- Heart palpitations.
- Increased heart rate.
- Weak or distant heart sounds.
- Abdominal swelling or leg swelling
- A feeling of weakness, fatigue, or being unwell.
- Distended jugular veins.
In the majority of pericarditis cases, doctors attribute the condition to a viral infection or are unable to determine the cause. Pericarditis can also develop after the heart muscle is damaged due to a heart attack or surgery. In some cases, pericarditis does not occur until several weeks following the heart attack or surgery in a phenomenon known as Dressler syndrome. It is believed that Dressler syndrome may be due to a delayed inflammatory response by the body. Other potential causes of pericarditis include:
- Autoimmune diseases, such as lupus and rheumatoid arthritis.
- Trauma to the chest wall resulting from a vehicle or other type of accident.
- Health conditions, including kidney failure, tuberculosis, and HIV
- Certain medications.
- Radiation therapy to the chest.
- Mesothelioma, which a form of cancer linked to asbestos exposure.
Diagnosis & Tests
Pericarditis can be difficult to distinguish from other cardiac conditions, such as cardiomyopathy. In addition to medical history and symptoms, the doctor will listen to the heart for sounds characteristic of pericarditis that are caused by the pericardial layers rubbing against one another. Blood tests and other tests may be used to rule out the possibility of a heart attack, to determine if there is fluid in the pericardium, and whether there is a viral or bacterial infection. An EKG may be used to measure the electrical activity of the heart.
A chest X-ray can help identify issues with the shape or structure of the heart and show if there is excess fluid in the pericardial sac. An echocardiogram uses sounds waves to provide the doctor with an image of the heart muscle and its structures. It can also identify if there is fluid accumulating in the pericardium.
CT scans are useful in ruling out other causes of sudden chest pain, including aortic dissections and pulmonary embolisms. It can also show if there is thickening of the pericardium, which is indicative of constrictive pericarditis. MRIs use radio waves and a magnetic field to reveal changes to the pericardium, such as thickening and inflammation. A cardiac catheterization can be used to measure pressure within the heart as the chambers fill with blood, which can confirm suspected constrictive pericarditis.
Treatment & Therapy
The goal of treatment is to improve the functioning of the heart. The doctor will determine the appropriate treatment protocol based on the underlying cause and severity of the symptoms. The first line of treatment is typically medications designed to reduce the swelling and inflammation in the pericardium. Many patients respond well to over-the-counter pain relievers such as aspirin or ibuprofen. These drugs often reduce the pain and inflammation of pericarditis within a couple of days and may be the only treatment needed.
Colchicine is an anti-inflammatory drug that may be used in cases of acute pericarditis that last for more than a couple of weeks or that recur. Colchicine is not appropriate for patients with kidney disease or liver disease or who take certain medications. If the pericarditis does not respond to over-the-counter medications or colchicine, the doctor may turn to corticosteroid medications, such as prednisone.
Diuretics, also known as water pills, may be prescribed if the patient is exhibiting signs of fluid build-up. Antibiotics or antifungals may be used if the condition is due to certain types of infections. If fluid accumulates in the pericardium to the point that the heart is unable to beat effectively, the patient may require a pericardiocentesis. This involves inserting a catheter or needle into the pericardium to drain the excess fluid. In cases of constrictive pericarditis, a pericardiectomy may have to be performed to remove the rigid pericardial sac so that the heart can pump effectively.
Prevention & Prophylaxis
During the recuperation period, it may be necessary to limit physical activity that can exacerbate symptoms. Most patients are able to resume normal activities once they are fully recovered.