Health Encyclopedia

Pericarditis

Definition

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

Causes, incidence, and risk factors

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection.

Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal infections can also produce pericarditis.

In addition, pericarditis can be associated with diseases such as:

Other causes include:

Heart attack (see post-MI pericarditis)
Injury (including surgery) or trauma to the chest, esophagus, or heart
Medications that suppress the immune system
Myocarditis
Radiation therapy to the chest

Often the cause of pericarditis remains unknown. In this case, the condition is called idiopathic pericarditis.

Pericarditis most often affects men aged 20-50. It usually follows respiratory infections. In children, it is most commonly caused by adenovirus or coxsackie virus.

Symptoms

Ankle, feet and leg swelling (occasionally)
Anxiety
Breathing difficulty when lying down
Chest pain, caused by the inflamed pericardium rubbing against the heart
- May radiate to the neck, shoulder, back or abdomen
- Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
- Pleuritis type: a sharp, stabbing pain
- Usually relieved by sitting up and leaning forward
Dry cough
Fatigue
Fever
Need to bend over or hold the chest while breathing

Signs and tests

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

Crackles in the lungs
Decreased breath sounds
Other signs of fluid in the space around the lungs (pleural effusion)

If fluid has built up in the pericardial sac, it may show on:

Chest MRI scan
Chest x-ray
ECG
Echocardiogram
Heart MRI or heart CT scan
Radionuclide scanning

These tests show:

Enlargement of the heart
Signs of inflammation
Scarring and contracture of the pericardium (constrictive pericarditis)

Other findings vary depending on the cause of pericarditis.

To rule out heart attack, the health care provider may order serial cardiac marker levels (CK -MB and troponin I). Other laboratory tests may include:

Blood culture
CBC
C-reactive protein
Erythrocyte sedimentation rate (ESR)
HIV serology
Pericardiocentesis, with chemical analysis and pericardial fluid culture
Tuberculin skin test

Treatment

The cause of pericarditis must be identified, if possible.

Medications include:

Analgesics for pain
Antibiotics for bacterial pericarditis
Antifungal medications for fungal pericarditis
Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
Corticosteroids such as prednisone
Colchicine
Diuretics to remove excess fluid in the pericardial sac

If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it is necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or a minor surgery.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.

Expectations (prognosis)

Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

Complications

Arrhythmias
Cardiac tamponade
Constrictive pericarditis, which may develop into heart failure

Calling your health care provider

Call your health care provider if you experience the symptoms of pericarditis. This disorder can be life-threatening if untreated.

Prevention

Many cases are not preventable.

References

LeWinter MM. Pericardial Diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.

Review Date:5/15/2008
Reviewed By:Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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