What Is It?
Acute pericarditis is an inflammation of the pericardium, the saclike membrane that encloses the heart. Pericarditis can be triggered by many, very different medical conditions, including:
- Viral infection — Viral pericarditis can be caused by an infection by several types of viruses, including coxsackieviruses, echoviruses, adenoviruses, the human immunodeficiency virus (HIV) or the viruses that cause mumps or hepatitis.
- A pyogenic (pus-producing) infection — Pyogenic pericarditis is a pus-producing infection surrounding the heart. It has several causes, including rupture of the esophagus, an infection after cardiothoracic surgery, or the spread of endocarditis, an infection of the heart lining and heart valves.
- Tuberculosis — Tuberculous pericarditis can occur as part of an active tuberculosis infection.
- Uremia — Uremic pericarditis can occur in people with uremia, an accumulation of urea and other waste products in the blood caused by kidney failure.
- heart attack (myocardial infarction) — Acute pericarditis can be triggered by the destruction of heart muscle in a heart attack.
- Cardiac injury — As in heart attack, heart damage caused by trauma (a stab wound or severe blow to the chest) or cardiac surgery also can trigger pericarditis.
- Rheumatic or collagen vascular disease — Rheumatic diseases (rheumatoid arthritis, scleroderma and polyarteritis nodosa) and collagen vascular diseases, especially systemic lupus erythematosus (SLE or lupus), also can cause acute pericarditis.
Other rare causes of acute pericarditis include radiation therapy to treat cancers in the chest, a tumor that has originated in the chest or spread (metastasized) to the pericardium from another part of the body, syphilis, a fungal infection or a parasitic infection. When no definite cause can be determined, acute pericarditis is referred to as acute idiopathic pericarditis.
In some people with pericarditis, a fluid (effusion) accumulates within the saclike pericardium, a condition called pericardial effusion. If the pericardial effusion is large enough, it can interfere with the heart’s ability to fill normally and to pump blood, a condition called Cardiac tamponade. In other people, acute pericarditis progresses to constrictive pericarditis, a condition in which the inflamed pericardium thickens and contracts around the heart, interfering with heart function.
The classic symptoms of pericarditis are fever and chest pain. This chest pain can be either brief and sharp or steady and constricting. It usually centers under the breastbone, but it also can spread to the neck and/or shoulders. In many patients, chest pain becomes more severe if they take a deep breath, swallow, cough or lie down, but sitting up or leaning forward may relieve the pain.
In patients whose acute pericarditis has progressed to Cardiac tamponade, there can be low blood pressure and shortness of breath. Patients with constrictive pericarditis also can suffer from breathing difficulties, together with edema (swelling) of the ankles, legs and abdomen.
Your doctor will review your medical history, especially any history of recent viral infection, heart attack, chest trauma, chest surgery, tuberculosis, kidney disease, rheumatic disease or collagen vascular disorder. Your doctor also will ask you to describe specific details about your chest pain, including its location, what triggers it (cough, swallowing, deep breath), how long it lasts and what relieves it.
Your doctor will perform a physical examination using a stethoscope to listen for a pericardial friction rub. This is a characteristic grating, leathery sound that can appear in patients with pericarditis. Other tests that can give your doctor further evidence of pericarditis include an electrocardiogram (EKG), an echocardiogram (a painless scan that uses sound waves to delineate structures in and around the heart) and sometimes a simple chest X-ray. In selected cases, a magnetic resonance imaging (MRI) or computed tomography (CT) scan also may be needed to look for changes in the pericardium. If a pericardial effusion has developed, a sample of the fluid may be drawn off with a sterile needle (aspirated) from around your heart and sent for laboratory analysis. Also, depending on the specific suspected cause of the pericarditis, you may need a skin test for tuberculosis or additional blood testing to look for signs of infection, heart attack, rheumatic illness or collagen vascular disease.
In some forms of pericarditis, especially those caused by most viral infections, heart attack or chest trauma, symptoms usually subside within one month or less. In other forms of pericarditis (uremic, rheumatic, collagen vascular disease), the condition can be long-term.
Because pericarditis can be the result of so many very different illnesses, there are no routine prevention guidelines. In general, you can help prevent pericarditis caused by heart-damaging infections by practicing good hygiene, especially frequent handwashing, and by seeing your doctor for recommended immunizations. To prevent pericarditis caused by heart attack, you can reduce your risk of coronary artery disease by not smoking, eating a low-fat diet, exercising regularly and controlling hypertension and diabetes if you have these problems. To reduce your risk of trauma-related pericarditis, you should wear a seat belt whenever you drive and wear appropriate chest-protecting equipment when you play contact sports.
Unfortunately, even if you follow all of these suggestions, some forms of pericarditis cannot be prevented.
The treatment of acute pericarditis depends on the cause. In general, the patient is told to rest in bed and to take aspirin or an anti-inflammatory drug, such as indomethacin (Indocin) for pain. If pain persists, the doctor may switch you to a glucocorticoid medication, such as prednisone (sold under several brand names). Patients with tuberculous pericarditis will need anti-tuberculosis medication. Those with a pyogenic bacterial infection will need strong antibiotics. Patients with uremic pericarditis caused by kidney failure will need a more intensified program of hemodialysis.
In patents whose pericarditis has evolved into Cardiac tamponade, excess fluid around the heart will be withdrawn with a sterile needle in a procedure called pericardiocentesis. When constrictive pericarditis interferes with heart function, the thickened pericardium may be removed surgically in a procedure called a pericardiectomy.
When To Call A Professional
Call your doctor whenever you have chest pain, whether or not you have a fever.
Most people with viral pericarditis recover within one month, although up to 25 percent of recovered patients suffer at least one recurrence. If you have frequent recurrences that continue to occur for more than two years, a pericardiectomy may be necessary.
People with pericarditis caused by heart attack or cardiac trauma also recover in one to two weeks. Other forms of pericarditis (uremic, collagen vascular, rheumatic) may wax and wane depending on course of the underlying medical illness.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.