What is pericarditis?
The pericardium is a protective lining that surrounds the heart. Pericarditis is an inflammation of the pericardium.What causes pericarditis?
Pericarditis can be caused by infection, heart attack, autoimmune disorders, chest trauma, cancer, kidney failure, or drugs.Infections that can cause pericarditis include viral infections, bacterial infections, tuberculosis, and fungal infections. Patients with AIDS frequently develop infections that produce pericarditis.
Autoimmune disorders that can cause pericarditis include rheumatoid arthritis, lupus, and scleroderma.
Pericarditis occurs in up to 15% of patients who have acute myocardial infarctions (heart attacks). There is also a late form of post-heart-attack pericarditis, called Dressler’s syndrome, that occurs weeks to months after the heart attack.
Some of the drugs that can produce pericarditis include procainamide, hydralazine, phenytoin, and isoniazid.
Many forms of cancer can metastasize (spread) to the pericardial sac, and produce pericarditis.
In many cases, no definite cause for pericarditis can be identified - this is called “idiopathic" pericarditis.”
What symptoms are associated with pericarditis?
The most common symptom caused by pericarditis is chest pain. The pain can severe, and is often made worse by changing position or with deep breathing. Patients can also have shortness of breath, or fever.Pericarditis can produce complications, namely tamponade, chronic pericarditis, and constriction. These complications - which are discussed below – can produce reduced cardiac pumping, lung congestion, and organ failure.
How is pericarditis diagnosed?
Doctors can usually diagnose pericarditis by taking a careful medical history, performing a physical examination, and doing an ECG (which shows characteristic changes.) Sometimes an echocardiogram can be helpful in making the diagnosis.What complications can occur with pericarditis?
While pericarditis usually resolves within a few days or a few weeks, three complications can occur. These are tamponade, chronic pericarditis, or constrictive pericarditis. Tamponade occurs when fluid accumulating in the pericardial sac (a condition called pericardial effusion) prevents the heart from filling completely. When this happens, the blood pressure drops and the lungs become congested, and the patient experiences weakness, dizziness and lightheadedness, and extreme shortness of breath. If treatment is not given, death can occur. The diagnosis of tamponade is made with an echocardiogram.Chronic pericarditis occurs when the pericardial inflammation does not resolve within a few weeks. It can be associated with all the symptoms of acute pericarditis, and in addition is often accompanied by particularly large pericardial effusions. Constrictive pericarditis occurs when a chronically inflamed pericardial sac sticks to the heart muscle, squeezing it constricting it. The symptoms are the same as with tamponade, but usually have a much more gradual onset. The diagnosis usually requires a careful cardiac catheterization. A CT or MRI scan can also help to diagnose chronic or constrictive pericarditis, by showing the thickening of the pericardial lining associated with these conditions.
How is pericarditis treated?
Acute pericarditis is treated by a) identifying the underlying cause, b) treating the underlying cause, c) giving anti-inflammatory drugs (to reduce inflammation and help prevent chronic problems), and d) giving analgesics to control the pain. Most cases of acute pericarditis resolve within a few weeks, and leave no permanent cardiac problems. Tamponade is treated by draining the fluid from the pericardial sac, usually via a tiny catheter. Removing the fluid relieves the pressure on the heart, and restores normal cardiac function almost immediately.Chronic pericarditis is treated by identifying and treating the underlying cause, if possible. If recurrent pericardial effusions become a problem, surgery can be done to create a permanent opening that allows the fluid to drain from the pericardial sac, thus preventing tamponade.
Constrictive pericarditis is a very difficult therapeutic problem. Symptoms can be treated with bed rest, diuretics, and digitalis, but definitive treatment requires surgery to strip the thickened pericardial lining from the heart. This surgery is usually quite difficult.
