Definition
Pericarditis is the irritation and swelling of the pericardium, the two-layered
sac that envelops the heart. Pain is caused when the inflamed layers rub together
or against the heart. The inflammation may in turn cause fluids to build up within
the sac. Complications include cardiac tamponade (excessive fluid buildup that squeezes the heart)
and constrictive pericarditis (scarring and stiffening of the pericardial sac).
Causes
Most often, pericarditis is caused by a viral
infection such as influenza, meningitis,
mumps, infectious mononucleosis, intestinal tract
disorder, or complications from acquired immunodeficiency syndrome.
Bacterial pneumonia, meningitis, or influenza; other bacterial
infections such as empyema, tuberculosis,
or skin and wound diseases; and fungal infections can also spread to
the pericardium and cause inflammation. Pericarditis may also be related to
cancer, chest trauma (including surgery), kidney failure, autoimmune disease, and
radiation therapy. Often the cause is unknown.
Risk Factors
Anyone can develop pericarditis; however, the condition is most common in men age twenty to fifty years. Children younger than four years of age are more apt to develop bacterial pericarditis. After an acute episode, 15 to 30 percent of people will have a recurrence; some will develop chronic pericarditis.
Symptoms
Pericarditis caused by a virus typically comes on suddenly and is short-lived, whereas bacterial pericarditis may develop gradually. Sharp chest pain is the most common symptom, although some people report dull pain or pressure; chronic episodes can be painless. The neck, left shoulder, back, and abdomen may also be affected, and pain may worsen with deep breathing and coughing or when lying flat; the pain may ease when sitting upright or bending forward. Shortness of breath is also common, as is a dry cough, fatigue, an increased heart rate, and a fever. In cases of constrictive pericarditis, the legs and ankles may swell; with cardiac tamponade, blood pressure levels may drop.
Screening and Diagnosis
The affected person’s symptoms, especially from any recent flulike infections, are important in the diagnosis. During the physical examination, the clinician will use a stethoscope to listen for the scratchy sound of the pericardium rubbing against the heart and for other signs of fluid buildup. A chest radiograph, echocardiogram, and computed tomography scan can confirm fluid buildup or other signs of pericardial damage. Cultures of the blood and pericardial fluid can detect bacterial or fungal infections.
Treatment and Therapy
Treatment generally depends on the underlying cause. Pericarditis caused by a
virus usually resolves within three weeks; affected persons are advised to rest
and are given medications to relieve pain and reduce inflammation. Persons who do
not respond to this regimen may be given corticosteroids or colchicine. Antibiotics
or antifungal medications are also prescribed for bacterial pericarditis. Those
with fluid buildup or other complications are typically hospitalized for
observation and further testing. Fluids may be drained from the pericardial sac,
which requires local anesthetic. For persons with chronic or constrictive
pericarditis, part or all of the pericardium may be surgically removed.
Prevention and Outcomes
Untreated bacterial pericarditis can be life-threatening. Prompt medical treatment and follow-up can help to prevent complications or a second attack.
Bibliography
Berger, John. “Pericarditis, Bacterial.” Available at http://emedicine.medscape.com/article/891369-overview.
Spodick, David H. The Pericardium: A Comprehensive Textbook. New York: Marcel Dekker, 1997.
Sydell and Arnold Miller Family Heart and Vascular Institute. Pericarditis Guide. Cleveland, Ohio: Cleveland Clinic, 2009. Available at http://my.clevelandclinic.org/documents/heart/pericarditis_treatment_guide.pdf.
Zipes, Douglas P., et al., eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia: Saunders/Elsevier, 2005.
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