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Pericarditis

Pericarditis

Definition

Pericarditis is an inflammation of the two layers of the thin, sac-like membrane that surrounds the heart. This membrane is called the pericardium, so the term pericarditis means inflammation of the pericardium.

Description

Pericarditis is fairly common. It affects approximately one in 1,000 people. The most common form is caused by infection with a virus. People in their 20s and 30s who have had a recent upper respiratory infection are most likely to be affected, along with men aged 20-50. One out of every four people who have had pericarditis will get it again, but after two years these relapses are less likely.

Causes and symptoms

The viruses that cause pericarditis include those that cause influenza, polio, and rubella (German measles ). In children, the most common viruses that cause pericarditis are the adenovirus and the cocksackievirus (which is most likely to affect children during warmer weather).

Although pericarditis is usually caused by a virus, it also can be caused by an injury to the heart or it can follow a heart attack. It may also be caused by certain inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus. Bacteria, fungi, parasites, tuberculosis, cancer or kidney failure may also affect the pericardium. Sometimes the cause is unknown.

There are several forms of pericarditis, depending on the cause.

Acute pericarditis

This is caused by infection with a virus, bacteria, or fungususually in the lungs and upper respiratory tract. This form of the disease causes a sharp, severe pain that starts in the region of the breastbone. If the pericarditis is caused by a bacteria, it is called bacterial or purulent pericarditis.

Cardiac tamponade

Sometimes fluid collects between the heart and the pericardium. This is called pericardial effusion, and may lead to a condition called cardiac tamponade. When the fluid accumulates, it can squeeze the heart and prevent it from filling with blood. This keeps the rest of the body from getting the necessary supply of oxygen and can cause dangerously low blood pressure. A cardiac tamponade can happen when the chest is injured during surgery, radiation therapy, or an accident. Cardiac tamponade is a serious medical emergency and must be treated immediately.

Constrictive pericarditis

When the pericardium is scarred or thickened, the heart has difficulty contracting. This is because the pericardium has shrunken or tightened around the heart, constricting the muscle's heart movement. This usually occurs as a result of tuberculosis, which now is rarely found in the United States, except in immigrant, AIDS, and prison populations.

Symptoms of pericarditis

Symptoms likely to be associated with pericarditis include:

  • rapid breathing
  • breathlessness
  • dry cough
  • fever and chills
  • weakness
  • broken blood vessels (hemorrhages) in the mucus membrane of the eyes, the back, the chest, fingers, and toes
  • feelings of anxiety
  • A sharp or dull pain that starts in the front of the chest under the breastbone and radiates to the left side of the neck, upper abdomen, and left shoulder the pain is less intense when the patient sits up or leans forward and worsens when lying down; it may worsen with a deep breath, like pleurisy, which may accompany pericarditis

In cardiac tamponade, neck veins may be swollen and blood pressure may be very low.

Diagnosis

The heart of a person with pericarditis is likely to produce a grating sound (friction rub) when heard through a stethoscope. This sound occurs because the roughened pericardium surfaces are rubbing against each other.

The following tests will also help diagnose pericarditis and what is causing it:

  • electrocardiograph (ECG) and echocardiogram to distinguish between pericarditis and a heart attack.
  • x ray to show the traditional "water bottle" shadow around the heart that is often seen in pericarditis where there is a sufficient fluid build up.
  • computed tomography scan (CT scan) of the chest.
  • heart catheterization to view the heart's chambers and valves.
  • pericardiocentesis to test for viruses, bacteria, fungus, cancer, and tuberculosis.
  • blood tests such as LDH and CPK to measure cardiac enzymes and distinguish between a heart attack and pericarditis, as well as a complete blood count (CBC) to look for infection.

Treatment

Since most pericarditis is caused by a virus and will heal naturally, there is no specific, curative treatment. Ordinary antibiotics do not work against viruses. Pericarditis that comes from a virus usually clears up in two weeks to three months. Medications may be used to reduce inflammation, however. They include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Corticosteroids are helpful if the pericarditis was caused by a heart attack or systemic lupus erythematosus. Analgesics (painkillers such as aspirin or acetaminophen ) also may be given.

If the pericarditis recurs, removal of all or part of the pericardium (pericardiectomy) may be necessary. In the case of constrictive pericarditis, the pericardiectomy may be necessary to remove the stiffened parts of the pericardium that are preventing the heart from beating correctly.

If a cardiac tamponade is present, it may be necessary to drain excess fluid from the pericardium. Pericardiocentesis, the same procedure used for testing, will be used to withdraw the fluid.

For most people, home care with rest and medications to relieve pain are sufficient. A warm heating pad or compress also may help relieve pain. Sitting in an upright position and bending forward helps relieve discomfort. A person with pericarditis may also be kept in bed, with the head of the bed elevated to reduce the heart's need to work hard as it pumps blood. Along with painkillers and antibiotics, diuretic drugs ("water pills") to reduce fluids may also be used judiciously.

Prognosis

Prognosis is good. Most people recover within three weeks to several months and do not need any additional treatment.

KEY TERMS

Computed tomography (CT) scan A CT scan uses x rays to scan the body from many angles. A computer compiles the x rays into a picture of the area being studied. The images are viewed on a monitor and printed-out.

Echocardiogram An echocardiogram bounces sound waves off the heart to create a picture of its chambers and valves.

Electrocardiogram (ECG) An ECG is a test to measure electrical activity in the heart.

Heart catheterization A heart catheterization is used to view the heart's chamber and valves. A tube (catheter) is inserted into an artery, usually in the groin. A dye is then put into the artery through the tube. The dye makes its way to the heart to create an image of the heart on x-ray film. The image is photographed and stored for further examination.

Pericardiocentesis Pericardiocentesis is a procedure used to test for viruses, bacteria, and fungus. The physician puts a small tube through the skin, directly into the pericardial sac, and withdraws fluid. The fluid then is tested for viruses, bacteria, and fungus.

Pericardium The pericardium is the thin, sac-like membrane that surrounds the heart. It has two layers: the serous pericardium and the fibrous pericardium.

Prevention

There is no way to prevent pericarditis, but a healthy lifestyle with proper nutrition and exercise will help keep the body's immune system strong and more likely to fight off invading microorganisms.

Resources

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300 or (800) 242-8721. inquire@heart.org. http://www.americanheart.org.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

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pericarditis

pericarditis (pe-ri-kar-dy-tis) n. acute or chronic inflammation of the pericardium. Pericarditis may be seen alone or as part of pancarditis. It has numerous causes, including virus infections, uraemia, and cancer. acute p. pericarditis characterized by fever, chest pain, and a pericardial friction rub. Fluid may accumulate within the pericardial sac (pericardial effusion). chronic constrictive p. chronic thickening of the pericardium, which interferes with activity of the heart and has many features in common with heart failure.

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