Cardiovascular Institute and Center for Cardiovascular Health

Pericarditis

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The pericardium is a sac of tough fibrous tissue that envelops the heart and the roots of the blood vessels which enter and leave the heart. The small amount of lubricating fluid (approximately 30 ml) contained in the sac and the sac's incomplete attachment to the heart allow the heart to move within it.

Pericarditis is the name given to a variety of diseases, all of which have the major characteristics of inflammation of the pericardium and an increase in volume of the pericardial fluid.

Pericarditis may be acute or chronic. It may be completely cured or may recur. Pericarditis is a progressive disease which can be life-threatening if not treated in a timely manner.

Most people do not have any symptoms or merely have the symptoms of an underlying disease. If you have pericarditis, you may experience chest pain. The pain may come on suddenly.

What causes pericarditis?
Usually, pericarditis is the consequence of another disease, often an infection. The infection may be bacterial, viral, or occasionally, fungal. Some other diseases which cause pericarditis are: kidney failure, tuberculosis, cancer, rheumatoid arthritis, rheumatic fever, lupus, and scleroderma.

Pericarditis may develop as a complication of myocardial infarction (heart attack). Radiation treatment or surgical complications may also cause pericarditis. On rare, occasions, pericarditis may develop as a reaction to certain medications.

Pericarditis is sometimes caused by injury or trauma such as gunshot or stab wounds, even if there is no penetration.

What is acute pericarditis?
Typically, acute pericarditis is accompanied by symptoms of sharp, stabbing chest pain, shortness of breath, fever, perspiration, chills, and the symptoms of the underlying illness. The chest pain may radiate to your neck, back, left shoulder and upper arm. The pain may intensify during respiration, coughing, swallowing, or when you are lying supine or turning.

If you have acute pericarditis, expect it to last 2 to 3 weeks. You may experience one or more recurrences in the 6 to 12 month period following your convalescence.

What is chronic pericarditis?
If your pericarditis persists for 6 months to twelve months following the acute episode, it is considered chronic.

What is constrictive pericarditis?
Constrictive pericarditis is a serious form of pericarditis in which the pericardium becomes so thickened and scarred that it loses some of its elasticity. It compresses the heart, interferes with the ability of the heart to fill up with blood, and reduces the amount of blood pumped out to the body. Constrictive pericarditis may cause heart failure and lead to kidney disease.

If you have constrictive pericarditis, you may experience chest pain, difficulty in breathing, swelling of your feet and ankles, fatigue, and weakness.

You may be given a low dose of diuretics (water pills) to gradually decrease excess fluid. You may be given pain killers and put on a low sodium diet.

If you have severe symptoms which are not alleviated by other means, surgery may be recommended. The surgery involves a high risk procedure called a "pericardiectomy" This procedure entails the removal of a portion or all of the pericardium to relieve the constriction.

Constrictive pericarditis may be life threatening if untreated.

What is adhesive pericarditis?
Adhesions may be present between the layers of the pericardium or between the pericardium and other parts of the chest area. This is not a serious condition, but if untreated, it may develop into constrictive pericarditis.

What should I know about viral pericarditis?
If you have viral pericarditis, you may have chest discomfort or pain and fever. You probably have had a recent upper respiratory infection.

The viruses most likely to cause pericarditis are: Coxsackie B, mumps, infectious mononucleosis, influenza, poliomyelitis, and occasionally chickenpox,

You can expect the illness to last 1 to 2 weeks. Most likely you will not have a recurrence.

What should I know about bacterial pericarditis?
Bacterial pericarditis is rare. It generally occurs in debilitated, chronically ill people who have other underlying diseases. Bacterial pericarditis very rarely occurs as an isolated illness.

If you have bacterial pericarditis, you may experience the following symptoms: shortness of breath, night sweats, cough, a high, spiking fever, an elevated pulse, the symptoms of the bacterial infection, and the symptoms of the underlying disease. The symptoms of the underlying disease vary.

Bacterial pericarditis is treated with antibiotic medication, by drainage of excess fluids and sometimes by early pericardiectomy surgery to prevent constrictive pericarditis.

The incidence of bacterial pericarditis has declined sharply with the advent of penicillin and other antibiotics.

What is fungal pericarditis?
If you have fungal pericarditis, you are probably already severely ill with another disease such as lymphoma, leukemia or endocarditis. Fungal pericarditis is often a complication of a pulmonary (lung) infection or may be a complication of cardiac surgery. The symptoms are usually the same as those of the underlying disease. If left untreated, fungal pericarditis will progress to pericardial constriction. The treatment includes medication for the underlying infection.

What is uremic pericarditis?
Uremic pericarditis is caused by kidney failure and may be treated by dialysis, which is a procedure that filters and cleanses the blood. This procedure may be necessary to reduce the severity of your symptoms. In rare, but serious situations, a pericardiectomy will be performed. If you have uremic pericarditis, your symptoms may include chest pain and a fever.

How is pericarditis diagnosed?
Your doctor will take your medical history and perform a complete physical examination. He will order diagnostic tests. These may include blood tests, chest x-rays, electrocardiograms (ECGs) and echocardiograms. He may order Computed Tomography (CT) and Magnetic Resonance imaging (MRI) scans to determine if there has been a thickening of the pericardium. He may order a diagnostic biopsy.

How is pericarditis treated?
Most people are treated for pericarditis outside the hospital setting. Treatment may include: pain killers, antibiotics, antituberculous agents, fungicidal drugs, dialysis, and chemotherapy, depending upon the type and basis of the disease.

Sometimes pericarditis is treated in the hospital. If you need to be hospitalized, you will be given strict bed rest until your symptoms abate. In the hospital, you will receive pain killers. You may be given corticosteroids to hasten the healing. You may undergo a process called "pericardiocentesis" in which the fluid in your pericardium will be drained through a catheter which is placed into your pericardial cavity. The drainage may take many hours to overnight. Finally, you may have to undergo surgery.

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