What Is Pericarditis?

Pericarditis is an inflammation of the thin, fluid-filled membrane sac surrounding the heart. This membrane sac is called the pericardium. Occurring mostly in men ages 20 to 50, pericarditis is marked by sharp pain in the chest’s center or left side. Scientists have identified a number of potential causes, with viral infections being primary. Mild cases of pericarditis often heal on their own; more severe cases can generate serious health risks and require corrective treatment.

What Are the Symptoms of Pericarditis?

The single most prominent symptom of pericarditis is chest pain. This pain can be described as:

• Pointed and severe
• Worse when lying down or breathing in
• Less bad, but still unpleasant, when sitting up or breathing out

The fact that pericardial pain lessens with a change in body position helps distinguish it from angina, or the pain associated with cardiac arrest or heart failure. Other symptoms of pericarditis include:

• Pain radiating from your chest into your upper back, neck, or left shoulder
• Coughing
• Leg swelling
• Weakness and fatigue
• Heart palpitations
• Fever

Pericarditis can also be classified by strength and duration of symptoms:

• Acute pericarditis: An attack of three weeks or less in duration.
• Incessant pericarditis: An attack of four weeks to three months in duration.
• Recurrent pericarditis: An attack that resumes after a four-to-six week interval without symptoms.
• Chronic pericarditis: Attacks that run longer than three months.

What Causes Pericarditis?

The physiological source of pain is the friction resulting from the swollen pericardial membranes. The cause of this swelling is more difficult to determine. Medical researchers have identified a number of possible factors:

• Viral, bacterial, or fungal infections, with viral being most common
• Parasite infestation
• Autoimmune diseases, such as lupus, rheumatoid arthritis, and scleroderma
• Traumatic injury
• Other health disorders, including kidney diseases, AIDS, and cancer
• In rare cases, medications

Chronic pericarditis has also been linked to more serious medical conditions, including constrictive pericarditis, a thickening and stiffening of the heart’s exterior membranes, and cardiac tamponade, a buildup of fluid in the pericardium. Both of these conditions place additional stress on the heart and can be fatal if not properly diagnosed and treated.

How Is Pericarditis Diagnosed?

There are several steps your physician can take to identify pericarditis and how intensively to treat it. These include:

• Documentation of symptoms: Your physician will ask about your chest pain and other symptoms – their nature, location, and duration. He or she will also want to know if you or members of your family have a history of heart disease or any other health condition that’s been linked to pericarditis.
• Physical exam: Your physician will use a stethoscope to listen for a pericardial rub, which is the sound made when the irritated membranes of the pericardium scrape against one another. You may also undergo one or more diagnostic tests looking for evidence of infection, inflammation, or fluid collection in the region around the heart.

If there is reason to suspect an underlying medical issue involving your heart, your physician may order:

• An electrocardiogram (EKG or ECG): EKGs measure your heart’s electrical activity as evidence for pericarditis or a more serious condition, such as myocardial infarction – heart attack.
• An echocardiogram: An echocardiogram uses ultrasound technology to provide a visual record of your heart’s structure and operation. Echocardiograms can detect fluid buildup in the pericardium.
• A chest X-ray: X-rays record the heart’s size and shape, which are vital clues as to the presence of pericarditis.
• A computerized tomography scan (CT scan): CT scans provide a more fine-grained snapshot of the heart than a chest X-ray. CT scans are sometimes used to rule out alternative explanations for the symptoms that you’re experiencing.
• Magnetic resonance imaging (MRI): MRIs are a medical-imaging technology that utilizes magnets and radio waves rather than ionizing radiation. MRI scanners offer detailed visual evidence for swelling, thickening, and other facets of pericarditis.

How Is Pericarditis Treated?

Mild pericarditis is typically self-healing. The most serious cases may require a surgical procedure, in addition to pain-relief medications.

Pain Relief

The following drugs have proven useful in treating pericarditis:

• Pain Relievers: Both over-the-counter pain relievers, such as aspirin or ibuprofen, and prescription medications can reduce swelling and lessen pain in persons suffering from pericarditis.
• Corticosteroids: Steroid medications, such as prednisone, have also been effective in controlling pericardial symptoms.
• Colchicine: Physicians often turn to the anti-inflammatory medication, colchicine, for recurrent pericardial attacks. Its usefulness is limited, however, for individuals with certain liver or kidney conditions.

Surgical Procedures

Two of the riskiest complications of pericarditis are constrictive pericarditis and cardiac tamponade. Treating these conditions may require hospitalization and surgery:

• Pericardiectomy: This procedure relieves pressure on the heart caused by a rigid pericardium (constrictive pericarditis). The surgeon removes the defective pericardium, allowing the heart to pump freely again.
• Pericardiocentesis: Cardiac tamponade is treated by this procedure, which involves the insertion of a catheter into the pericardium to drain away excess fluid. The catheter may remain in place for several days before the process is completed.