Pericarditis is inflammation of the pericardium, a membrane that surrounds the heart and its major blood vessels.
Pericarditis can be caused by:
- heart attack
- autoimmune disorders
- chest trauma
- kidney failure
Pericarditis most often affects men aged 20-50. Pericarditis may be acute or chronic. Heart attack (see post-MI pericarditis) and myocarditis can cause pericarditis, as can radiation therapy to the chest and medications that suppress the immune system. Acute pericarditis due to tuberculosis begins insidiously, sometimes without obvious symptoms of lung infection. It may produce fever and symptoms of heart failure, such as weakness, fatigue, and difficulty breathing. Cardiac tamponade may occur. Pericarditis can be misdiagnosed as myocardial infarction, and vice versa. Pericarditis is more common in adolescents and young adults. In a recent study, Merce et al found no difference in etiology, clinical course, and prognosis between elderly and younger patients with moderate and large pericardial effusions.
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. Chronic pericarditis occurs when the pericardial inflammation does not resolve within a few weeks. Constrictive pericarditis occurs when a chronically inflamed pericardial sac sticks to the heart muscle, squeezing it constricting it. 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. Potential sources of cardiac perforation include central line placement, pacemaker insertion, cardiac catheterization, sternal bone marrow biopsies, and pericardiocentesis.
Pericarditis usually occurs in flare-ups, but it may be the presenting manifestation. Constrictive pericarditis is a very difficult therapeutic problem. Diuretics may be used to remove excess fluid accumulated in the pericardial sac. Bacterial pericarditis must be treated with antibiotics. Fungal pericarditis is treated with antifungal agents. Medicines, such as aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs), are commonly used to manage the pain and inflammation. Acute inflammatory pericarditis usually lasts one to three weeks and doesn’t lead to further problems. About 20 percent of pericarditis patients have a recurrence within months or, rarely, within years. Pericarditis is treated with bed rest, diuretics, and digitalis, but definitive treatment requires surgery to strip the thickened pericardial lining from the heart.
Treatment for Pericarditis
- Analgesics or anti-inflammatory drugs are given to relieve pain.
- Antibiotics are also prescribed if the pericarditis is due to a bacterial infection.
- 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.
- Pericarditis is treated with bed rest, diuretics, and digitalis.