Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.
Causes, incidence, and risk factors
The cause of pericarditis is often unknown or unproven, but is often the result of an infection such as:
- Viral infections that cause a chest cold or pneumonia, such as the echovirus or coxsackie virus (which are common in children), as well as influenza
- Infections with bacteria (much less common)
- Some fungal infections (even more rare)
In addition, pericarditis may be seen with diseases such as:
Cancer (including leukemia)
Disorders in which the immune system attacks healthy body tissue by mistake
HIV infectionand AIDS
Underactive thyroid gland
Other causes include:
Heart surgery or trauma to the chest, esophagus, or heart
Certain medications, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system
Swelling or inflammation of the heart muscle
Radiation therapy to the chest
Often the cause of pericarditis is unknown. Pericarditis most often affects men ages 20 – 50.
Chest pain is almost always present. The pain:
- May be felt in the neck, shoulder, back, or abdomen
- Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
- Can be a sharp, stabbing pain
- Is often relieved by sitting up and leaning or bending forward
You may have fever, chills, or sweating if the condition is caused by an infection.
Other symptoms include:
Ankle, feet, and leg swelling(occasionally) Anxiety Breathing difficulty when lying down
Signs and tests
When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The
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 (
The following imaging tests may be done to check the heart and the tissue layer around it (pericardium):
Chest MRI scan Chest x-ray Echocardiogram
Heart MRIor heart CTscan
- Radionuclide scanning
To look for heart muscle damage, the health care provider may order a troponin I test. Other laboratory tests may include:
Antinuclear antibody(ANA) Blood culture CBC C-reactive protein
- Erythrocyte sedimentation rate (
- HIV test
- Rheumatoid factor
Tuberculin skin test
The cause of pericarditis must be identified, if possible.
High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often given. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart.
A medicine called colchicine may be added, especially if pericarditis does not go away after 1 to 2 weeks or it comes back weeks or months later.
If the cause of pericarditis is an infection:
- Antibiotics will be used for bacterial infections
- Antifungal medications will be used for fungal pericarditis
Other medicines that may be used are:
Corticosteroids such as prednisone (in some patients)
“Water pills” (diuretics) to remove excess fluid
If the buildup of fluid makes the heart function poorly, treatment may include:
- Draining the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle.
- Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity
If the pericarditis is
Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by fluid buildup around the heart and poor heart function.
The outcome is good if the disorder is treated right away. Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic if symptoms or episodes continue.
Scarring and thickening of the sac-like covering and the heart muscle may occur in severe cases. This is called
Calling your health care provider
Call your health care provider if you have symptoms of pericarditis. This disorder is usually not life threatening, but it can be if not treated.
Many cases are not preventable.