Pericarditis

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Pericarditis

Topic Overview

Picture of the heart

What is pericarditis?

Pericarditis is a swelling and irritation of the pericardium, which is the sac that surrounds your heart.

What causes pericarditis?

Most of the time the cause is either not known or is thought to be a viral infection.

Less common causes include:

  • Heart attack.
  • Infection from a virus or bacteria, such as HIV or tuberculosis.
  • Chest injury.
  • Recent heart surgery.
  • Diseases, such as lupus, hypothyroidism, or kidney disease.
  • Medicine side effects, including cancer treatments.

What are the symptoms?

The main symptom is a sharp pain in the centre of your chest or in the left side of your chest. This pain may spread to the shoulder blade. For some people, this pain is dull instead of sharp. The pain may be worse when you lie down or take a deep breath.

The pain lasts for hours or days and does not get better when you rest. It is different from a type of chest pain called angina, which only lasts a short time and usually gets better with rest.

Other symptoms may include a mild fever, weakness, feeling very tired, coughing, hiccups, and muscle aches.

Pericarditis usually is not dangerous, but your chest pain could be caused by something more serious, like a heart attack. And getting diagnosed and treated early can help keep pericarditis from leading to other problems. That’s why you should call a doctor right away if you have any kind of sudden chest pain.

Can complications of pericarditis develop?

Pericarditis usually does not cause serious problems. Most people get better in 7 to 10 days. When there are problems, they may include:

  • A buildup of fluid in the pericardial sac (pericardial effusion). See a picture of pericardial effusion.
  • Sudden pressure on the heart and sudden difficulty pumping enough blood (called cardiac tamponade). This can be caused by the weight and pressure of the fluid buildup if it happens quickly.
  • Constrictive pericarditis, which can be caused by pericarditis that comes back or lasts longer than normal. The sac around the heart gets thick and stiff. This makes it harder for the heart to pump blood.

How is pericarditis diagnosed?

Your doctor will listen to your heart during a physical examination. He or she will also ask questions about your medical history, such as whether you've had a recent virus, radiation treatment for cancer, or tuberculosis.

Your doctor may want you to have several tests, including an electrocardiogram, a chest X-ray, and blood tests.

If the chest X-ray shows any fluid buildup, or if you have symptoms that last more than 10 days, your doctor will want you to have a test called an echocardiogram.

How is it treated?

If there are no other problems, pericarditis usually goes away on its own in a few weeks. Your doctor may suggest pain relievers that you can buy without a prescription to help take care of your pain or discomfort. In some cases, the doctor may prescribe stronger medicine.

Frequently Asked Questions

Learning about pericarditis:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with pericarditis:

Symptoms

Symptoms of pericarditis include:

  • Chest pain. A sharp or dull constant pain often develops. The pain may be located in the centre of the chest and sometimes extends over the left shoulder. Deep breathing, lying down, or swallowing may make the pain worse. Sitting up and leaning forward may improve it.
  • Mild fever.
  • A general feeling of weakness, fatigue, or light-headedness.
  • Shortness of breath.
  • Coughing.
  • Hiccups.
  • Muscle aches.

The type of chest pain that occurs with pericarditis differs from angina, which usually becomes worse with exertion but does not change with deep breathing. You should tell your doctor anytime you have chest pain. In the early stages of pericarditis, it may be hard to tell whether the pain is from the inflammation or from a possible heart attack.

If you develop complications of pericarditis, you are at risk for sudden heart failure. Symptoms of sudden heart failure include sudden severe shortness of breath, a sudden irregular or rapid heartbeat, and a cough that brings up foamy pink mucus. Sudden heart failure is a medical emergency that requires immediate care. If you experience any symptoms of sudden heart failure, call 911 or quickly get other emergency medical help.

Examinations and Tests

Medical history and physical examination

A physical examination and a review of your medical history will help a doctor diagnose pericarditis, its complications, and any related conditions.

A doctor will ask questions about your symptoms and general health and may ask whether you've had any flu-like symptoms recently and whether you've ever had any serious infections, such as tuberculosis. Having had cancer, radiation treatments for cancer, or significant injuries to the chest are also important clues to help diagnose pericarditis.

Your doctor will listen to your heart for a sound called a pericardial friction rub, which often occurs with pericarditis. A pericardial friction rub sounds like Velcro being pulled apart. A friction rub is thought to be caused by tissue membranes as they rub together. Sometimes it is difficult to hear or recognize.

Electrocardiogram (EKG or ECG)

An inflamed pericardium can affect your heart's regular electrical impulses. An electrocardiogram (EKG or ECG) can identify any abnormal electrical activity.

Several electrocardiograms may be done over a period of weeks to monitor the heart during the treatment of pericarditis.

Chest X-ray

A chest X-ray can show the size of your heart. Your heart may look larger than normal if you have complications of pericarditis. A chest X-ray can also help your doctor find out whether you have other conditions, such as tuberculosis or pneumonia.

Echocardiogram

Echocardiogram (echo) is useful for diagnosing fluid in the sac around the heart (pericardial effusion). See a picture of pericardial effusion.

An echocardiogram is also used to check whether fluid is putting pressure on the heart (cardiac tamponade) and whether there is stiffening of the sac around the heart (constrictive pericarditis).

Blood tests

A variety of blood tests can help your doctor find out whether you have inflammation somewhere in your body, including the pericardium, or whether you have another condition that is causing the pericarditis.

Pericardiocentesis

Pericardiocentesis is a procedure that may be used if you have fluid buildup in the pericardium (pericardial effusion). During pericardiocentesis, a doctor numbs the skin on your chest, inserts a needle and sometimes a thin tube called a catheter into the area around the heart, and removes some fluid. This fluid can be sent to the lab for testing to help determine the cause of pericarditis. Removing fluid also relieves pressure on the heart.

Treatment Overview

Viral pericarditis usually improves on its own with time. Mild pain relievers may be all you need to relieve inflammation and control pain. Bacterial pericarditis requires antibiotics in addition to pain relievers.

Other conditions that may be causing pericarditis will also be treated.

If complications develop and pressure on the heart (cardiac tamponade) is a concern, your doctor may need to drain fluid from the pericardial sac.

Medicines

ASA, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and relieve the pain of pericarditis. Sometimes stronger medicines are also used for pain relief.

Another type of medicine called colchicine may be used to treat pericarditis and prevent repeat (recurrent) episodes. Colchicine may be tried if other medicines do not improve your pericarditis. Colchicine also reduces inflammation, but it works differently than NSAIDs. Colchicine may be used along with NSAIDs.

In rare cases, your doctor may prescribe stronger anti-inflammatory medicines called corticosteroids, such as prednisone. Corticosteroids are usually used only for severe inflammation that does not respond to milder medicines. In some cases, corticosteroids may make pericarditis worse.

If a bacterial infection is causing pericarditis, your doctor will prescribe antibiotics to treat it.

Be sure to report to your doctor any medicines that you are already taking. If you have pericarditis, taking anticoagulant medicines can cause bleeding into the pericardial space (hemorrhagic pericardial effusion).

Medical procedures

Your doctor may drain excess fluid buildup (pericardial effusion) in the area between the pericardium and the heart in a procedure called pericardiocentesis. This procedure is also done to reduce pressure (cardiac tamponade) around the heart. Pericardiocentesis involves using a needle and sometimes a thin tube called a catheter to drain the fluid. The need for pericardiocentesis is usually determined by how well the heart is functioning. If fluid builds up gradually and the heart is tolerating the increased fluid around it, treatment of the cause may be tried first.

Constrictive pericarditis

Constrictive pericarditis is a rare complication of pericarditis that can keep the heart from pumping well. Some people develop shortness of breath, swollen legs and feet, and other symptoms of heart failure.

Your doctor may recommend a low-sodium diet, medicines such as diuretics to reduce your heart's workload, and limited activity. If symptoms persist and are severe, you may need surgery to remove the scarred part of the pericardial sac. This helps loosen the pericardium's tight hold around the heart and allows the heart to pump more effectively.

Home Treatment

As with any heart disease, it is important to follow your doctor's advice for home treatment for pericarditis and to watch for any signs of complications or a return of pericarditis, especially shortness of breath.

Get plenty of rest until you are feeling better, especially if you have a fever. Avoid all strenuous activity that has not been approved by your doctor. Also, it is vital that you take your medicines, especially antibiotics, as directed and keep all follow-up appointments with your doctor to monitor your recovery from an episode of pericarditis.

Other Places To Get Help

Organizations

Canadian Cardiovascular Society
222 Queen Street
Suite 1403
Ottawa, ON  K1P 5V9
Phone: 1-877-569-3407 toll-free
(613) 569-3407
Fax: (613) 569-6574
Web Address: www.ccs.ca
 

The Canadian Cardiovascular Society works to advance the cardiovascular health and care of Canadians through leadership, research, and advocacy.


Heart and Stroke Foundation of Canada
222 Queen Street
Suite 1402
Ottawa, ON  K1P 5V9
Phone: (613) 569-4361
Fax: (613) 569-3278
Web Address: www.heartandstroke.ca
 

The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.


Texas Heart Institute
P.O. Box 20345
Houston, TX  77225-0345
Phone: 1-800-292-2221 (Heart Information Service hotline)
(832) 355-4011 (general line)
Email: his@heart.thi.tmc.edu (Heart Information Services)
Web Address: www.texasheartinstitute.org
 

The Texas Heart Institute's national telephone hotline is staffed by medical professionals who can answer heart-related health questions. The Web site provides information on a wide range of heart topics, including common disorders and prevention programs.


U.S. National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

Related Information

References

Other Works Consulted

  • Hoit BD (2008). Pericardial disease. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1951–1974. New York: McGraw-Hill Medical.
  • Howlett JG, et al. (2009). Canadian Cardiovascular Society consensus conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy, and recent important clinical trials. Canadian Journal of Cardiology, 25(2): 85–105.
  • LeWinter MM (2008). Pericardial diseases. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1829–1853. Philadelphia: Saunders Elsevier.
  • Maisch B, et al. (2004). Guidelines on the diagnosis and management of pericardial diseases. Executive summary. European Heart Journal, 25(7): 587–610.
  • Shafi S, Oh JK (2008). Diseases of the pericardium, cardiac tumors, and cardiac trauma. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chapter 13. Hamilton, ON: BC Decker.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Last Revised May 9, 2011

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