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.
