Reviewed by Brian R. Robinson, MDPericarditis is an inflammation of the pericardium, the fluid-filled sac surrounding the heart. Pericarditis may occur as a mild symptom of a viral infection.
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In that case it can be treatable with medication, or it may will resolve itself on its own. It can, however, lead to heart failure or other serious conditions.
The pericardium is a thin, permeable sac that surrounds the heart. Its purpose is to keep the heart in place, prevent the heart from overfilling with blood, and protect the heart from infections. Normal, small amounts of fluid Fluid between the pericardium and the heart (pericardial fluid) enables the two to move without friction between them.
Pericarditis is an inflammation of the pericardium. When the pericardium is inflamed, larger than normal amounts of fluid can accumulate between it and the heart. This can increase pressure on the heart and cause fluid to leak out into the body. The pericardium can also rub against the heart, causing friction and pain. Eventually, in chronic cases, the sac can lose elasticity, scar, and actually adhere to the heart.
There are two main types of pericarditis, acute and chronic. Acute pericarditis is develops rapidly and is sometimes temporary, while chronic pericarditis builds up gradually and lasts longer. Constrictive pericarditis is a complication that can arise in chronic cases; in this case, scar tissue forms around the heart and gradually compresses it, causing fluid to leak out of the heart and accumulate under the skin, in the abdomen or around the lungs. Constrictive pericarditis also means that the heart cannot properly fill with blood. This can lead to right-sided heart failure.
Cardiac tamponade is a life-threatening complication that can develop from pericarditis. It occurs when fluid builds up rapidly and puts pressure on the heart. This condition can also develop independently of the inflammation that characterizes pericarditis, caused by many of the same factors, including lupus, recent heart attack, kidney failure or injury.
Causes
Any number of infections and conditions may cause pericarditis. The same conditions can cause either acute or chronic pericarditis, or cardiac tamponade. Usually, however, the cause is unknown.
- Viral infections such as the mumps, mononucleosis (mono), tuberculosis, AIDS or hepatitis B
- Prior heart attack. About 5% of heart attack survivors will develop pericarditis as a symptom. Usually it develops within a week, but it can still occur up to three months after the attack.
- Lupus Erythematosus
- Cancer, including leukemia(cancer of the blood cells)
- Kidney failure
- Aortic aneurysm
- Rheumatoid arthritis
- As a side effect of certain drugs, including anticoagulants, penicillin, procainamide, phenytoin, and phenylbutazone
- Radiation treatment for breast cancer or lymphoma
Symptoms
Symptoms of acute pericarditis include fever and chest pain, which may extend to the left shoulder and arm, as in a heart attack. The pain may feel worse when the patient lies down, coughs, or breathes deeply.
In chronic pericarditis, a back-up of fluid in the lungs can cause shortness of breath and coughing. Reduced heart performance can cause fatigue. Constrictive pericarditis can also cause a swelling of legs or abdomen (associated with right-sided heart failure, and distended neck veins.
To diagnose acute pericarditis, the doctor will first examine the heart with a stethoscope. If the pericardium is inflamed, the doctor will detect a high–pitched creaking noise called a pericardial friction rub. Chest x-ray and echocardiograms can show the extent of fluid build-up.
These techniques and more are used to diagnose chronic pericarditis. Cardiac catheterization can measure the pressure in the heart and blood vessels. MRI and CT scans enable the doctor to measure the thickness of the pericardium. Chronic constrictive pericarditis can thicken the pericardium to more than twice its original 1/8 of an inch thick.
Treatment then depends on the underlying cause. Usually, all types of pericarditis will initially be treated with drugs. Anti-inflammatories like aspirin may be enough to alleviate the pain of acute pericarditis; stronger pain medication may also be used. For chronic pericarditis, diuretics may be used to remove excess fluid.
If the condition is too serious for drug treatment alone, the next step is to surgically drain the excess fluid from between the pericardium and the heart. Pericardiocentesis is the most common; in this procedure, the fluid is drained with a catheter. This procedure is commonly used to treat cardiac tamponade, as that condition is more immediately dangerous than pericarditis. Pericardiotomy is another drainage procedure.
In serious situations, the pericardium may be surgically removed. This procedure (called pericardiectomy) has a risk of death of between 5 and 15%, so it is undertaken only if the condition substantially interferes with quality of life. A person can live without the pericardium.
