Pericarditis
What is Acute pericarditis?
Pericarditis is an inflammation of the sac-like structure that surrounds and confines the heart (pericardium or pericardial sac). Acute pericarditis may be caused by viral infections, tumors, radiation therapy, drugs, and other diseases. It also occurs shortly after heart surgery, heart attack, or trauma.
How is it diagnosed?
Acute Pericarditis signs and symptoms
Chest pain is usually present and can be severe. The individual may mistake it for a heart attack. The pain is sharp and worsens by breathing in or coughing. Others may have a steady pain, originating in the center of the chest, and radiating to the arms. In almost all cases, pain is relieved markedly when the individual sits up and leans forward. Pain is usually absent in pericarditis caused by chronic kidney failure (uremic pericarditis), cancer, or after radiation therapy. The most important signs are apparent only on medical examination.
Physical exam: Fever may be present when the pericarditis is caused by an infection. The most important physical sign is a pericardial friction rub, heard with a stethoscope, which changes with different positions.
Tests: Usual tests include blood work, a urine analysis, chest x-rays, an electrocardiogram, and an echocardiogram. Cardiac catheterization or angiocardiography may be used to confirm the diagnosis, if necessary.
How is Pericarditis treated?
Treatment is focused on relieving the acute symptoms and treating any underlying cause of the problem. Viral pericarditis may require only bedrest and aspirin. Occasionally, steroids or antibiotics may be prescribed.
Medications
Imuran (Azathioprine), Motrin (Ibuprofen), Naprosyn (Naproxen), Voltaren (Diclofenac), Indocin (Indomethacin), Colcrys (Colchicine)
Activity
- Rest in bed until fever and pain subside.
- Resume your normal activities gradually.
- Resume sexual relations when fever and pain disappear.
What might complicate it?
Acute pericarditis is often accompanied by fluid buildup (effusion) in the pericardial sac. When the fluid accumulates it can constrict the heart obstructing blood flow into the chambers of the heart, and reduce blood flow out of the heart. This condition is called cardiac tamponade.
Tamponade may occur within minutes after cardiac trauma or rupture causing shock and occasionally death, but it usually develops over time. In the case of fluid buildup, the individual must be monitored to avoid the development of tamponade. It may be necessary to perform pericardiocentesis (drainage with a needle) to remove fluids and to relieve pressure. In persistent cases of effusion where drainage is continually needed, typically with tumors or kidney disease, it may be necessary to surgically remove part of the pericardium (pericardiectomy).
Predicted outcome
Most cases of acute pericarditis heal within six weeks. There may be recurrences in the first few weeks or months. Some individuals may develop chronic constrictive pericarditis.
Alternatives
The symptoms of acute pericarditis can mimic a heart attack (particularly in middle-aged men). It may be the first visible sign of an important underlying problem such as lupus erythematosus, tuberculosis, or cancer.
Appropriate specialists
Cardiologist and cardiovascular surgeon.
Last updated 6 April 2018