Pericarditis

Content provided by the Faculty of the Harvard Medical School

Pericarditis

What Is It?

Pericarditis is an inflammation of the pericardium, the saclike membrane around the heart. Pericarditis can be triggered by many, very different medical conditions, including:

• Viral infection — Viral pericarditis can be caused by an infection by several types of viruses, including coxsackieviruses, echoviruses, adenoviruses, the human immunodeficiency virus (HIV) and the viruses that cause mumps or hepatitis.

• A pyogenic (pus-producing) infection — Pyogenic pericarditis is an infection surrounding the heart that produces pus. It has several causes, including rupture (breaking open) of the esophagus (food tube), an infection after cardiothoracic surgery, or the spread of endocarditis, an infection of the heart lining and heart valves.

• Tuberculosis — Tuberculous pericarditis can occur as part of an active tuberculosis infection.

• Uremia — Uremic pericarditis can occur in people with uremia, an accumulation of urea and other waste products in the blood caused by kidney failure.

• Heart attack (myocardial infarction) — Pericarditis can be triggered by the destruction of heart muscle in a heart attack.

• Cardiac injury — As in heart attack, heart damage caused by trauma (a stab wound or severe blow to the chest) or cardiac surgery also can trigger pericarditis.

• Rheumatic or collagen vascular disease — Rheumatic diseases (rheumatoid arthritis, scleroderma and polyarteritis nodosa) and collagen vascular diseases, especially systemic lupus erythematosus (SLE or lupus), also can cause pericarditis.

Other rare causes of pericarditis include radiation therapy to treat cancers in the chest, cancer in the chest area, syphilis, a fungal infection or a parasitic infection. Sometimes, no definite cause can be found.

In some people with pericarditis, a fluid (effusion) accumulates within the saclike pericardium, a condition called pericardial effusion. If the pericardial effusion is large enough, it can interfere with the heart's ability to fill normally and to pump blood, a condition called cardiac tamponade. In other people, the earlier stage of pericarditis progresses to constrictive pericarditis, a condition in which the inflamed pericardium thickens and contracts around the heart, interfering with heart function.

Symptoms

The classic symptoms of pericarditis are fever and chest pain. This chest pain can be either brief and sharp or steady and constricting. It is usually under the breastbone, but it also can spread to the neck or shoulders. In many patients, chest pain becomes more severe if they take a deep breath, swallow, cough, or lie down. Sitting up or leaning forward may relieve the pain.

Patients with cardiac tamponade can have low blood pressure and shortness of breath. Patients with constrictive pericarditis also can have breathing difficulties, together with edema (swelling) of the ankles, legs and abdomen.

Diagnosis

Your doctor will review your medical history, especially any history of recent viral infection, heart attack, chest trauma, chest surgery, tuberculosis, kidney disease, rheumatic disease or collagen vascular disorder. Your doctor also will ask you to describe your chest pain, including its location, what triggers it (cough, swallowing, deep breath), how long it lasts and what relieves it.

Your doctor will examine you, using a stethoscope to listen for a characteristic grating, leathery sound that can appear in patients with pericarditis. This sound is called a pericardial friction rub. Other tests that can give your doctor further evidence of pericarditis include:

• An electrocardiogram (EKG)

• An echocardiogram, a painless scan that uses sound waves to delineate structures in and around the heart

• A simple chest X-ray

• Amagnetic resonance imaging (MRI) or computed tomography (CT) scan, needed in some cases to look for changes in the pericardium

If a pericardial effusion has developed, a sample of the fluid may be drawn off (aspirated) from around your heart with a sterile needle and examined in a laboratory. Also, depending on the suspected cause of the pericarditis, you may need a skin test for tuberculosis or additional blood testing to look for signs of infection, heart attack, rheumatic illness or collagen vascular disease.

Expected Duration

In some forms of pericarditis, especially those caused by most viral infections, heart attack or chest trauma, symptoms usually subside in one month or less. In other forms of pericarditis (uremic, rheumatic, collagen vascular disease), the condition can be long-term.

Prevention

Because pericarditis can be the result of so many very different illnesses, there are no routine guidelines to prevent the condition. In general, you can help prevent pericarditis caused by heart-damaging infections by practicing good hygiene, especially washing your hands often, and by seeing your doctor for recommended immunizations. To prevent pericarditis caused by heart attack, you can reduce your risk of coronary artery disease by not smoking, eating a low-fat diet, exercising regularly and controlling hypertension and diabetes if you have these problems. To reduce your risk of trauma-related pericarditis, you should wear a seat belt whenever you drive and wear appropriate chest-protecting equipment when you play contact sports.

Even if you follow all of these suggestions, some forms of pericarditis cannot be prevented.

Treatment

The treatment of acute pericarditis depends on the cause. You will be told to rest in bed and to take aspirin or an anti-inflammatory drug, such as indomethacin (Indocin) for pain. If pain continues, the doctor may switch you to a glucocorticoid medication, such as prednisone (sold under several brand names). Patients with tuberculous pericarditis will need anti-tuberculosis medication. Those with a pyogenic bacterial infection will need strong antibiotics. Patients with uremic pericarditis caused by kidney failure will need hemodialysis, a mechanical procedure to clean the blood.

If you have cardiac tamponade, excess fluid around your heart will be withdrawn with a sterile needle in a procedure called pericardiocentesis. When constrictive pericarditis interferes with heart function, the thickened pericardium may be removed surgically in a procedure called a pericardiectomy.

When To Call A Professional

Call your doctor whenever you have chest pain, whether or not you have a fever.

Prognosis

Most people with viral pericarditis recover within one month, although up to 25 percent of patients have the condition return at least once. If the condition returns repeatedly over more than two years, a pericardiectomy may be necessary.

People with pericarditis caused by heart attack or cardiac trauma usually recover in one to two weeks. Other forms of pericarditis (uremic, collagen vascular, rheumatic) may come and go depending on course of the underlying medical illness.

Additional Info

American Heart Association (AHA) 7272 Greenville Ave. Dallas, TX 75231 Toll-Free (800) 242-8721 Fax: (214) 706-2139 http://www.americanheart.org/

National Heart, Lung and Blood Institute (NHLBI) 6701 Rockledge Dr. P.O. Box 30105 Bethesda, MD 20824-0105 Phone: (301) 592-8573 E-Mail: NHLBIinfo@rover.nhlbi.nih.govhttp://www.nhlbi.nih.gov/

Last updated:	April 09, 2009