Pericarditis (patient information)

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Overview
Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

What are the symptoms of Pericarditis?

 * Chest pain, which is caused by the inflamed pericardium rubbing against the heart. The pain may radiate to the neck, shoulder, back, or abdomen.  The pain often increases with deep breathing and lying flat, and may increase with coughing and swallowing. Patient's may often feel better sitting up and leaning forward. There may be a pleuritic type pain (Pleuritis) which is a sharp, stabbing pain. In addition, the following symptoms may be observed:
 * Fever
 * Ankle, feet, and leg swelling (occasionally if there is a constriction of the heart filling ( a condition known as constrictive pericarditis).
 * Anxiety
 * Orthopnea or breathing difficulty when lying down.
 * Dry cough
 * Fatigue

What causes Pericarditis?
Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. In children, it is most commonly caused by adenovirus or coxsackie virus. Often the cause of pericarditis remains unknown. In this case, the condition is called idiopathic(unknown cause) pericarditis.

In addition, pericarditis can be associated with diseases such as:


 * Autoimmune disorders
 * Cancer (including leukemia)
 * Heart attack (see post-MI pericarditis)
 * HIV infection and AIDS
 * Hypothyroidism
 * Infections with bacteria can lead to bacterial pericarditis (also called purulent(pus) pericarditis). Some fungal infections can also produce pericarditis.
 * Kidney failure
 * Medications
 * Myocarditis a condition in which the heart is inflamed
 * radiation therapy
 * Rheumatic fever
 * Trauma (including surgery) or trauma to the chest, esophagus(food pipe), or heart
 * Tuberculosis

Who is at highest risk?
Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections.

When to seek urgent medical care?
Pericarditis can be potentially life threatening and one should seek medical care when suffering from symptoms of pericarditis. Severe chest pain, fainting, palpitations and high grade fever may be ominous signs and may indicate build up of fluids within the pericardium, a condition called cardiac tamponade where the heart cannot expand to accept blood.

Diagnosis
The cause of pericarditis must be identified, if possible, for this the physician may decide to do the following:
 * Chest MRI scan
 * Chest x-ray
 * ECG
 * Echocardiogram
 * Heart MRI or heart CT scan
 * Radionuclide scanning

Treatment options
Medications to treat pericarditis may include:

If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it may be necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or minor surgery.
 * Analgesics for pain
 * Antibiotics for bacterial pericarditis
 * Antifungal medications for fungal pericarditis
 * Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
 * Corticosteroids such as prednisone
 * Colchicine
 * Diuretics to remove excess fluid in the pericardial sac

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended as part of a procedure called pericardiectomy.

Where to find medical care for Pericarditis?
Directions to Hospitals Treating Pericarditis

What to expect (Outlook/Prognosis)?
Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

Possible complications

 * Pericardial effusion or accumulation of fluid around the heart.
 * Cardiac tamponade or compression of fluid on the heart that prevents the heart from filling normally.
 * Constrictive pericarditis which is scarring of the sack around the heart that prevents the heart from filling normally.

Prevention
Many cases are not preventable.

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