What Is Pericarditis?
Pericarditis (PER-i-kar-DI-tis) is a condition in
which the membrane, or sac, around your heart is inflamed. This sac is called
the pericardium (per-i-KAR-de-um).
The pericardium holds the heart in place and helps
it work properly. The sac is made of two thin layers of tissue that enclose
your heart. Between the two layers is a small amount of fluid. This fluid keeps
the layers from rubbing against each other and causing friction.
Pericardium
Figure A shows the
pericardiumthe sac surrounding the heart. Figure B is an enlarged
cross-section of the pericardium that shows its two layers of tissue and the
fluid between the layers.
In pericarditis, the layers of tissue become
inflamed and can rub against the heart. This causes chest pain—a common
symptom of pericarditis.
The chest pain from pericarditis may feel like pain
from a
heart
attack. If you have chest pain, you should call 9–1–1 right
away, as you may be having a heart attack.
Overview
Many factors can cause pericarditis. Viruses and
infections are common causes. Less often, pericarditis occurs after a heart
attack or
heart
surgery. Lupus, scleroderma, rheumatoid arthritis, or other autoimmune
disorders also can cause the condition. In about half of all cases, the cause
is unknown.
Pericarditis can be acute or chronic.
“Acute” means that it occurs suddenly and usually doesn’t
last long. “Chronic” means that it develops over time and may take
longer to treat.
Both acute and chronic pericarditis can disrupt your
heart’s normal function and possibly (although rarely) lead to death.
However, most cases of pericarditis are mild and clear up on their own or with
rest and simple treatment. Other times, more intense treatment is needed to
prevent complications. Treatment may include medicines and, less often,
procedures and/or surgery.
Outlook
It may take from a few days to weeks or even months
to recover from pericarditis. With proper and prompt treatment, such as rest
and ongoing care, most people fully recover from pericarditis. These measures
also can help reduce the chances of getting the condition again.
Other Names for Pericarditis
- Idiopathic (id-ee-o-PATH-ick) pericarditis. This
term refers to pericarditis with no known cause.
- Acute pericarditis.
- Chronic pericarditis.
- Chronic effusive pericarditis. This is a form of
chronic pericarditis.
- Chronic constrictive pericarditis. This also is a
form of chronic pericarditis.
What Causes Pericarditis?
The cause of about half of all pericarditis cases
(both acute and chronic) is unknown.
Viral infections are likely the most common cause of
acute pericarditis, but the virus may never be found. Pericarditis often occurs
after a respiratory infection. Bacterial, fungal, and other infections also can
cause pericarditis.
Less often, pericarditis is caused by:
- Autoimmune disorders, such as lupus, scleroderma,
and rheumatoid arthritis
- Heart
attack and
heart
surgery
- Kidney failure, HIV/AIDS, cancer, tuberculosis,
and other health problems
- Injury from accidents or radiation therapy
- Certain medicines, like phenytoin (an antiseizure
medicine), warfarin and heparin (blood-thinning medicines), and procainamide (a
medicine to treat abnormal heartbeats)
The causes of acute and chronic pericarditis are the
same.
Who Is At Risk for Pericarditis?
Pericarditis occurs in people of all ages. However,
men between the ages of 20 and 50 are more likely to get it.
People who are treated for acute pericarditis may
get it again. This may happen in 15 to 30 percent of people who have the
condition. A small number of these people go on to develop chronic
pericarditis.
What Are the Signs and Symptoms of Pericarditis?
Sharp, stabbing chest pain is a common symptom of
acute pericarditis. The pain usually comes on quickly. It often is felt in the
middle or the left side of the chest.
The pain tends to ease when you sit up and lean
forward. Lying down and deep breathing worsens it. For some people, the pain
feels like a dull ache or pressure in their chests.
The chest pain may feel like pain from a
heart
attack. If you have chest pain, you should call 9–1–1 right
away, as you may be having a heart attack.
Fever is another common symptom of acute
pericarditis. Other symptoms are weakness, trouble breathing, and coughing.
Chronic pericarditis often causes tiredness,
coughing, and shortness of breath. Chest pain is often absent in this type of
pericarditis. Severe cases of chronic pericarditis can lead to swelling in the
stomach and legs and
low
blood pressure (hypotension).
Complications of Pericarditis
Two serious complications of pericarditis are
cardiac tamponade (tam-po-NAD) and chronic constrictive pericarditis.
Cardiac tamponade occurs when too much fluid
collects in the pericardium (the sac around the heart). The extra fluid puts
pressure on the heart. This prevents the heart from properly filling with
blood. As a result, less blood leaves the heart. This causes a sharp drop in
blood pressure. If left untreated, cardiac tamponade can cause death.
Chronic constrictive pericarditis is a rare disease
that develops over time. It leads to scar-like tissue throughout the
pericardium. The sac becomes stiff and can’t move properly. In time, the
scarred tissue compresses the heart and prevents it from working correctly.
How Is Pericarditis Diagnosed?
Your doctor will diagnose pericarditis based on
your medical history and the results from a physical exam and tests.
Specialists Involved
Primary care doctors—such as a family doctor,
internist, or pediatrician—often diagnose and treat pericarditis. Other
types of doctors also may be involved. These include a cardiologist, pediatric
cardiologist, and an infectious disease specialist. A cardiologist treats
people who have heart problems. An infectious disease specialist treats people
who have infections.
Medical History
To learn more about your medical history, your
doctor may ask whether you:
- Have had a recent respiratory infection or
flu-like illness
- Have had a recent
heart
attack or injury to your chest
- Have any other medical conditions
Your doctor also may ask about your symptoms. If
you have chest pain, he or she will ask you to describe how it feels, where
it’s located, and whether it’s worse when you lie down, breathe, or
cough.
Physical Exam
When the pericardium (the sac around your heart) is
inflamed, the amount of fluid between its two layers of tissue increases. As
part of the exam, your doctor will look for signs of excess fluid in your
chest.
A common sign is the pericardial rub. This is the
sound of the pericardium rubbing against the outer layer of your heart. Your
doctor will place a stethoscope on your chest to listen for this sound.
Your doctor may hear other chest sounds that are
signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural
effusion). These are more severe problems related to pericarditis.
Diagnostic Tests
Your doctor may order one or more tests to diagnose
your condition and show how severe it is. The most common tests are:
- EKG
(electrocardiogram). This simple test detects and records the electrical
activity of your heart. Certain EKG results suggest pericarditis.
- Chest
x ray. A chest x ray takes pictures of your heart and lungs. The images can
show whether you have an enlarged heart. This is a sign of excess fluid in your
pericardium.
- Echocardiography.
This painless test uses sound waves to create pictures of your heart. The
pictures show the size and shape of your heart and how well your heart is
working. This test can show whether fluid has built up in the pericardium.
- Cardiac
CT (computed tomography). This is a type of x ray that takes a clear,
detailed picture of your heart and pericardium. CT helps rule out other causes
of chest pain.
- Cardiac
MRI (magnetic resonance imaging). This test uses powerful magnets and radio
waves to create detailed pictures of your organs and tissues. MRI can show
changes in the pericardium.
Your doctor also may order
blood
tests. These tests can help your doctor find out whether you’ve had a
heart attack, the cause of the pericarditis, and how inflamed your pericardium
is.
How Is Pericarditis Treated?
Most cases of pericarditis are mild and clear up on
their own or with rest and simple treatment. Other times, more intense
treatment is needed to prevent complications. Treatment may include medicines
and, less often, procedures and/or surgery.
The goals of treatment are to:
- Reduce pain and inflammation
- Treat the underlying cause, if it’s known
- Check for complications
Specific Types of Treatment
As a first step in your treatment, your doctor may
advise you to rest until you feel better and have no fever.
He or she may tell you to take over-the-counter,
anti-inflammatory medicines, such as aspirin or ibuprofen, to reduce pain and
inflammation. You may need stronger medicine if your pain is severe.
If your pain continues to be severe, your doctor may
prescribe a medicine called colchicine and, possibly, prednisone (a steroid
medicine).
If an infection is causing your pericarditis, your
doctor will prescribe an antibiotic or other appropriate medicine to treat the
infection.
You may need to stay in the hospital during
treatment so your doctor can check you for complications.
The symptoms of acute pericarditis can last from a
few days to 3 weeks. Chronic cases may last several months.
Other Types of Treatment
If you have complications of pericarditis,
you’ll need treatment for those problems. Two serious complications of
pericarditis are cardiac tamponade and chronic constrictive pericarditis.
Cardiac tamponade is treated with a procedure called
periocardiocentesis (PER-e-o-KAR-de-o-sen-TE-sis). A needle or tube (called a
catheter) is inserted into the chest wall to remove excess fluid that has
collected inside the pericardium. This relieves pressure on the heart.
If time allows, the fluid may be removed with a
special catheter or tube put through a small cut in the chest.
The only cure for chronic constrictive pericarditis
is surgery to remove the pericardium. This is known as a pericardiectomy
(PER-i-kar-de-EK-to-me).
The treatments for these complications require
hospital stays.
How Can Pericarditis Be Prevented?
You usually can’t prevent acute pericarditis.
But, you can take steps to reduce your chances of having another acute episode,
having complications, or getting chronic pericarditis.
These steps include getting prompt treatment,
following your treatment plan, and having ongoing medical care (as your doctor
advises).
Living With Pericarditis
Many cases of pericarditis are mild and clear up on
their own. But other cases, if not treated, can lead to chronic pericarditis
and serious problems that affect your heart. Some problems can be life
threatening.
In some cases, it may take weeks or months to
recover from a case of pericarditis. Full recovery is likely with rest and
ongoing care. These measures also can help reduce the chances of having the
condition again.
Key Points
- Pericarditis is a condition in which the
membrane, or sac, around your heart is inflamed. This sac is called the
pericardium.
- The pericardium holds the heart in place and
helps it work properly. The sac is made of two thin layers of tissue that
enclose your heart.
- In pericarditis, the layers of tissue become
inflamed and can rub against the heart, causing chest pain. The chest pain may
feel like pain from a
heart
attack. If you have chest pain, you should call 9–1–1 right
away, as you may be having a heart attack.
- Many factors can cause pericarditis. Viruses and
infections are common causes. Less often, pericarditis occurs after a heart
attack or
heart
surgery. Lupus, scleroderma, rheumatoid arthritis, or other autoimmune
disorders also can cause the condition. In about half of all cases, the cause
is unknown.
- Pericarditis can be acute or chronic.
“Acute” means that it occurs suddenly and usually doesn’t
last long. “Chronic” means that it develops over time and may take
longer to treat.
- Both acute and chronic pericarditis can disrupt
your heart’s normal function and possibly (although rarely) lead to
death.
- Pericarditis occurs in people of all ages.
However, men between the ages of 20 and 50 are more likely to get it.
- Sharp, stabbing chest pain and fever are common
symptoms of acute pericarditis. Other symptoms are weakness, trouble breathing,
and coughing. Chronic pericarditis often causes tiredness, coughing, and
shortness of breath. In severe cases, it can lead to swelling in the stomach
and legs and
low
blood pressure.
- Two serious complications of pericarditis are
cardiac tamponade and chronic constrictive pericarditis. These conditions can
disrupt your heart’s normal function. If left untreated, they may lead to
death.
- Your doctor will diagnose pericarditis based on
your medical history and the results from a physical exam and tests.
- Most cases of pericarditis are mild and clear up
on their own or with rest and simple treatment. Other times, more intense
treatment is needed to prevent complications. Treatment may include medicines
and, less often, procedures and/or surgery.
- You usually can’t prevent acute
pericarditis. But, you can take steps to reduce your chances of having another
acute episode, having complications, or getting chronic pericarditis. Get
prompt treatment, follow your treatment plan, and get ongoing medical care (as
your doctor advises).
- In some cases, it may take weeks or months to
recover from pericarditis. Full recovery is likely with rest and ongoing care.
These measures also can help reduce the chances of having the condition
again.
Links to Other Information About Pericarditis
Non-NHLBI Resources
Clinical Trials
|