Pericarditis
Pericarditis is an inflammation of the two layers of the thin, sac-like membrane that surrounds the heart. This membrane is called the pericardium; thus the term pericarditis means inflammation of the pericardium.
Pericarditis is fairly common. It affects approximately one in 1,000 people.The most common form is caused by a viral infection. People in their 20s and30s who have had a recent upper respiratory infection are most likely to be affected, along with men aged 20-50. One out of every four people who have hadpericarditis will get it again, but after two years these relapses are lesslikely to occur.
The viruses that cause pericarditis include those that cause influenza, polio, and rubella (German measles). In children, the most common viruses that cause pericarditis are the adenovirus and the cocksackievirus (which is most likely to affect children during warmer weather).
Although pericarditis is usually caused by a virus, it also can be caused byan injury to the heart or it can follow a heart attack. It may also be causedby certain inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus. Bacteria, fungi, parasites, tuberculosis, cancer, or kidney failure may also affect the pericardium. Sometimes the cause is unknown.
There are several forms of pericarditis, depending on the cause. One type ofpericarditis is caused by infection with a virus, bacteria, or fungus usuallyin the lungs and upper respiratory tract. This form of the disease causes asharp, severe pain that starts in the region of the breastbone. If the pericarditis is caused by a bacteria, it is called bacterial or purulent pericarditis.
Sometimes fluid collects between the heart and the pericardium. This is called pericardial effusion, and may lead to a condition called cardiac tamponade.When the fluid accumulates, it can squeeze the heart and prevent it from filling with blood. This block of blood-flow keeps the rest of the body from getting its necessary supply of oxygen and can cause dangerously low blood pressure. A cardiac tamponade can occur when the chest is injured during surgery,radiation therapy, or an accident. Cardiac tamponade is a serious medical emergency and must be treated immediately.
When the pericardium is scarred or thickened, the heart has difficulty contracting. This is because the pericardium has shrunken or tightened around the heart, constricting the muscle's heart movement. This usually occurs as a result of tuberculosis, which now is rarely found in the United States, except inimmigrant, AIDS, and prison populations.
Symptoms likely to be associated with pericarditis include:
- Rapid breathing
- Breathlessness
- Dry cough
- Fever and chills
- Weakness
- Broken blood vessels (hemorrhages) in the mucus membrane of the eyes, the back, the chest, fingers, and toes
- Feelings ofanxiety
- A sharp or dull pain that starts in the front of the chest under the breastbone and radiates to the left side of the neck, upper abdomen,and left shoulder. The pain is less intense when the patient sits up or leans forward and worsens when lying down. The pain may worsen with a deep breath, like pleurisy, which may accompany pericarditis.
The heart of a person with pericarditis is likely to produce a grating sound(friction rub) when heard through a stethoscope. This sound occurs because the roughened pericardium surfaces are rubbing against each other.
The following tests will also help diagnose pericarditis and what is causingit:
- Electrocardiograph (ECG) and echocardiogram to distinguish betweenpericarditis and a heart attack.
- X-ray to show the traditional "water bottle" shadow around the heart that is often seen in pericarditis where there is a sufficient fluid build up.
- Computed tomography scan(CT scan) of the chest.
- Heart catheterization to view the heart's chambers and valves.
- Pericardiocentesis to test for viruses, bacteria, fungus, cancer, and tuberculosis.
- Blood tests such as LDH and CPKto measure cardiac enzymes and distinguish between a heart attack and pericarditis, as well as a complete blood count (CBC) to look for infection.
Since most pericarditis is caused by a virus and will heal naturally, there is no specific, curative treatment. Ordinarily antibiotics do not work againstviruses. Pericarditis stemming from a virus usually clears up in 2 weeks to3 months. Medications may be used to reduce inflammation, however. They include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Corticosteroids are helpful if the pericarditis was caused by a heart attack or systemic lupus erythematosus. Analgesics (painkillers such as aspirin or acetaminophen) also may be given.
If the pericarditis recurs, removal of all or part of the pericardium (pericardiectomy) may be necessary. In the case of constrictive pericarditis, the pericardiectomy may be necessary to remove the stiffened parts of the pericardium that are preventing the heart from beating correctly. If a cardiac tamponade is present, it may be necessary to drain excess fluid from the pericardium. Pericardiocentesis, the same procedure used for testing, is used to withdraw the fluid.
For most people, home care with rest and medications to relieve pain are sufficient. A warm heating pad or compress also may help relieve pain. Sitting inan upright position and bending forward helps relieve discomfort. A person with pericarditis may also be kept in bed, with the head of the bed elevated to reduce the heart's need to work hard as it pumps blood. Along with painkillers and antibiotics, diuretic drugs ("water pills") to reduce fluids may alsobe used judiciously.
The prognosis for those with pericarditis is good. Most people recover withinthree weeks to several months and do not require any additional treatment.
Although pericarditis cannot be prevented, a healthy lifestyle with proper nutrition and exercise will help keep the body's immune system strong and morelikely to fight off invading microorganisms.