Everything you need to know about pericarditis
In many cases, the cause of pericarditis is not known, but it can be infectious or noninfectious and is the most common disease of the pericardium.
This MNT Knowledge Center article will discuss pericarditis' causes and symptoms and the interventions used to treat it.
Here are some key points about pericarditis. More detail and supporting information is in the main article.
- Pericarditis is a swelling of the pericardium, a sack-like tissue that contains the heart.
- The condition can have a number of causes, including bacterial or viral infection, parasites, or fungus.
- Most commonly, pericarditis is due to a virus.
- Symptoms of pericarditis include palpitations, a dry cough, and pain in the shoulder.
- In rare cases, pericarditis can permanently scar the pericardium.
What is pericarditis?
Pericarditis is an inflammation of the pericardial sac.
Pericarditis is an inflammation of the pericardium. The swelling causes a sharp pain as the affected pericardial layers rub together and irritate.
In general, pericarditis starts quickly and does not last long - this is known as acute pericarditis. If pericarditis lasts for a longer period, it is referred to as chronic pericarditis.
Chronic pericarditis is further split into two categories:
- Incessant: This type occurs within 6 weeks of weaning medical treatment for acute pericarditis.
- Intermittent: The type occurs after 6 weeks of reducing medical treatment for acute pericarditis.
Some clinicians further split pericarditis down into five groups, depending on the type of fluid that accumulates around the heart:
- Serous: This involves pale, yellow, transparent fluid.
- Purulent: This group is identified by the presence of white-yellow pus.
- Fibrinous: This group consists of fibrin, a blood clotting agent, and leukocytes, a type of white blood cells.
- Caseous: Caseous necrosis is a form of cell death. Affected tissue develops a cheese-like appearance
- Hemorrhagic: This type involves a blood-based fluid.
The symptoms of pericarditis can include the following:
- sharp pain in the chest, sometimes central, other times to the left, that may decrease in intensity when sitting up and leaning forward
- shortness of breath, especially when reclining
- minor fever
- general weakness
- swelling of the abdomen or legs
- a cough
- pain in the shoulder
The symptoms are very similar to a heart attack. It is imperative to seek medical attention if you experience chest pain. A doctor can then rule out less serious conditions and investigate the cause of the pericarditis.
If pericarditis is left untreated, it can get worse and become a more severe condition.
Complications of pericarditis include:
- Cardiac tamponade: If too much fluid builds up in the pericardium, it can put additional pressure on the heart, preventing it from filling with blood. This can cause a fatal drop in blood pressure if left untreated
- Constrictive pericarditis: This is a rare byproduct of pericarditis. Constrictive pericarditis involves a permanent thickening and scarring of the pericardium. This causes a hardening of the tissues and restricts the heart from working properly, potentially leading to swelling in the feet and legs and shortness of breath.
The pericardial sac, or pericardium, consists of two layers, separated by a small amount of fluid. This fluid keeps the movement between the two membranes smooth.
If the pericardium becomes infected and swells, the two layers will come into contact, causing friction.
In many cases, the primary cause of pericarditis cannot be found. It is therefore known as idiopathic pericarditis. Many cases are assumed to be caused by viral infections that cannot be detected.
Pericarditis is most often caused by a viral infection.
The following viruses are associated with acute pericarditis:
- enteroviruses, including the common cold and viral meningitis
- glandular fever
- herpes simplex
- adenoviruses including pneumonia and bronchitis
- hepatitis C
Pericarditis often arrives soon after a major heart attack. This is thought to be due to irritation of the underlying heart muscles. Similarly, pericarditis can occur after heart surgery.
Sometimes, pericarditis will occur weeks after a heart attack or operation. This is known as Dressler's syndrome. In this case, the cause is likely to be autoimmune.
Researchers believe that dead heart tissue enters the blood system and acts as an antigen, triggering an immune reaction. The body mistakenly reacts against the tissues of the heart and pericardium.
Other causes of pericarditis include:
- systemic inflammatory disorders, including rheumatoid arthritis or lupus
- kidney failure
- fungi, such as histoplasmosis and Candida
- underlying conditions, such as AIDS, cancer, and tuberculosis
- underactive thyroid
- certain medications, including penicillin, warfarin, and phenytoin
Initially, a doctor will listen to the chest. As the pericardial layers rub together, they can make a distinctive sound.
Further tests will be used to check if there has been a heart attack, if fluid has amassed in the pericardial sac or if there are any signs of inflammation.
The following diagnostic tools may be used:
- Chest X-ray: An X-ray will show up the shape of the heart, indicating whether it has enlarged due to excess fluid.
- CT: A CT can produce a more detailed image of the heart than standard X-rays and rule out other possible problems such as pulmonary clots and aortic tears,
- MRI of the heart: This uses radio waves and magnetic fields, this technique builds up an accurate picture of the width of the heart walls
- Echocardiogram: This builds up a detailed image of the heart using sound waves.
- Electrocardiogram (ECG): Patches and wires are applied to the chest to measure the electrical activity of the heart.
In most cases of pericarditis, the condition will not need treating.
The way in which pericarditis is treated depends on its severity and the underlying causes. In milder cases, a course of no action may be chosen as the illness commonly clears up of its own accord.
When necessary, the first line of treatment is medication.
Drug-based treatment options include:
- Over-the-counter (OTC) pain medicine: Without a prescription, OTC medicines, such as aspirin or ibuprofen, can ease much of the pain and inflammation experienced in pericarditis. Prescription-strength painkillers might also be used if necessary.
- Colchicine (Colcrys): If the pericarditis is particularly painful or recurrent, colchicine might be prescribed. This drug, which has anti-inflammatory effects, can minimize the duration and prevent recurrence. However, many people with existing conditions, such as liver or kidney disease, will be advised against taking it. Side effects include abdominal pain, vomiting, and diarrhea.
- Corticosteroids: If neither of the first two options have worked, corticosteroids may be employed. If steroids are given during the first attack of pericarditis, the person with pericarditis is more likely to have a relapse. For this reason, they are the last port of call. Side effects include weight gain, mood swings, and increased sweating.
If medications are not effective, surgical options include:
- Pericardiocentesis: A small tube is inserted into the pericardial cavity to drain excess fluid. The tube might be left inserted for several days
- Pericardiectomy: If the pericardium has become particularly rigid and is causing the heart additional stress, the entire sac might be removed by surgery. This is used a last resort, as there is a small risk of the operation causing death.
It can take between a few days and a few months to recover. However, most people make a full recovery.