Pericarditis

The pericardium is a thin, sac-like membrane that surrounds the heart, and the outer layer of the pericardium surrounds the roots of the heart’s major blood vessels. Ligaments attach the outer layer to the spinal column, diaphragm, and other parts of the body. The inner layer of pericardium is attached to the heart muscle. A coating of fluid separates the two layers of pericardium, which allows the heart to move as it beats while remaining attached to the body.

Pericarditis is inflammation of the pericardium. Pericarditis causes an increase in the amount of fluid between the two layers of the pericardium. The increased fluid pressures the heart and restricts its pumping action.

What Causes Pericarditis?

Pericarditis most often occurs in men between the ages of 20 and 50 years old. In most cases, the cause of pericarditis is unknown, but it can result from:

• A viral, bacterial, or fungal infection
• A heart attack or heart surgery
• Cancer that has spread from a nearby tumor
• Radiation treatment for some types of cancer
• Traumatic injury to the chest, esophagus, or heart
• Medicines that suppress the immune system

Pericarditis may also occur in patients who have rheumatoid arthritis, lupus, kidney failure, leukemia, HIV, or AIDS.

Symptoms

The main symptom of pericarditis is a sharp, stabbing pain in the center or left side of the chest. (In some cases, the pain may be dull.) The pain may spread to the neck or left shoulder and can worsen while taking a deep breath. The pain is usually lessened by sitting up or leaning forward and worsened by lying down. Other symptoms may include fever, cough, pain when swallowing, difficulty breathing, and an overall feeling of sickness.

Diagnosis

Pericarditis is suspected based on the symptoms and history of the pain. Additional testing may include:

• Using a stethoscope to listen for “rubbing” chest sounds, which indicate fluid around the heart, and “crackles” in the lungs, a sign of fluid in the space around the lungs.
• Taking a chest x-ray to see if the heart is enlarged due to increased pericardial fluid.
• Performing an electrocardiogram (ECG) to examine the heart’s rhythm, size, and function.
• Performing an echocardiogram to look at heart wall motion, overall heart size, and fluid buildup around the heart.
• Taking a sample of the fluid from the pericardium to test for signs of infection.
• Using imaging techniques such as computed tomography (CT) scanning and magnetic resonance imaging (MRI) if more complete information is needed.

Treatment

Pericarditis is treated with pain relievers and anti-inflammatory medicines. If pericarditis is caused by a bacterial infection, antibiotic medicines are also prescribed. If the increased fluid in the pericardium restricts the pumping action of the heart, a pericardiocentesis may be needed to remove the extra fluid. In rare cases, surgery may be needed. Acute pericarditis (a recent infection) usually lasts 1 to 3 weeks and causes no further problems; chronic pericarditis may last for several months and can sometime recur.


Resources

Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/pericard.cfm
American Heart Association www.americanheart.org/presenter.jhtml?identifier=4683
MedlinePlus www.nlm.nih.gov/medlineplus/ency/article/000182.htm