Pericarditis – Causes, Symptoms, Diagnosis, & Treatment
What is pericarditis?
Pericarditis is inflammation and irritation of the pericardium. The pericardium is a thin sac-like covering around the heart. This condition mostly affects men between ages 20 and 50.
What causes pericarditis?
What causes pericarditis is not known to doctors and scientists. In many cases, the cause is not found. Pericarditis is often caused by viral infections that cause a chest cold or pneumonia. Bacterial infections can also cause this condition, but less commonly. Rarely, some fungal infections can also cause pericarditis.
Pericarditis may be seen with diseases such as:
- Autoimmune disorders
- Rheumatic fever
- HIV infection and AIDS
- Tuberculosis (TB)
- Underactive thyroid gland
- Kidney failure
The following are the other causes that can result in pericarditis:
- Swelling or inflammation of the heart muscle
- Heart attack
- Heart surgery or trauma to the chest, esophagus, or heart
- Radiation therapy to the chest
- Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system
What are the symptoms of pericarditis?
Chest pain is the main symptoms of pericarditis. The pain may be felt in the neck, shoulder, back, or abdomen. It often increases with deep breathing and lying flat, and may also increase with coughing and swallowing. The pain can be sharp and stabbing. It is often relieved by sitting up and leaning or bending forward.
The following symptoms occur if pericarditis is caused by an infection:
The following other symptoms may also occur with pericarditis:
- Difficulty breathing when lying down
- A dry cough
- Swelling of ankles, legs, and feet
How is pericarditis diagnosed?
The doctor will perform a physical exam and review your symptoms. During the examination with a stethoscope, the doctor may hear an abnormal sound called a pericardial rub. The heart sounds may be muffled or distant. The doctor may find other signs of pericardial effusion (excess fluid in the pericardium).
If the pericarditis is severe, the doctor may hear:
- Crackles in the lungs
- Decreased breath sounds
- Other signs of fluid in the space around the lungs
The doctor may order the following imaging tests to check the heart and the pericardium:
- MRI scan of the chest
- Chest x-ray
- MRI or CT scan of the heart
- Radionuclide scanning
The doctor may order a troponin-I test to check if there is any damage to the heart muscle.
The doctor may also order the following laboratory tests:
- Blood culture
- Antinuclear antibody (ANA)
- C-reactive protein
- Erythrocyte sedimentation rate (ESR)
- Rheumatoid factor
- HIV test
- Tuberculin skin test
How is pericarditis treated?
If the cause of pericarditis is not identified, the doctor may treat the condition with medicines to decrease pain and reduce the swelling or inflammation in the pericardium. He/she may treat the condition with high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and may add a medicine called colchicine to NSAIDs.
If the pericarditis is caused by an infection, the doctor may treat the condition with antivirals for viral infections, antibiotics for bacterial infections, and antifungal medicines for fungal pericarditis
The doctor may recommend corticosteroids such as prednisone for some people and diuretics (water pills) to remove excess fluid.
If the fluid buildup makes the heart function poorly, the doctor may recommend the following treatment:
- Pericardiocentesis: This procedure is used to rain the fluid from the pericardium. This procedure is done using an echocardiography-guided needle.
- Subxiphoidpericardiotomy: This procedure involves making a small hole in the pericardium to allow the infected fluid to drain into the abdominal cavity
- Pericardiectomy: This surgical procedure involves cutting or removing part of the pericardium. This is used if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart.
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.