Pericarditis is a condition of inflammation directly affecting the heart. The heart is protected in a sac-like membrane (the pericardium) that separates it from the other organs and aids the contractions and other movements of the heart muscle. When the pericardium becomes inflamed, the primary symptom is chest pain. Acute pericarditis usually occurs suddenly, and often temporarily, but sometimes the symptoms develop gradually or persist, and this is known as chronic pericarditis.
Pericarditis can result from a viral infection. A major heart attack, however, can irritate the heart muscle, and this can also affect the pericardium. Other possible causes include the following:
- Rheumatoid arthritis, lupus or other systemic inflammatory disorders
- Chest trauma
- Kidney failure, AIDS, tuberculosis, cancer and other medical conditions
Dressler's syndrome is an autoimmune form of pericarditis due to antibody formation after a heart attack or heart surgery.
Symptoms of Pericarditis
The symptoms of pericarditis may be local (chest-related) or systemic, affecting the entire body:
- Sharp pain behind the breastbone or on left side of the chest
- Shortness of breath, especially when reclining
- Low-grade fever
- Weakness or fatigue
- Dry cough
- Swelling in the legs or abdomen
Using a stethoscope, your doctor will be able to hear a pericardial rub, which is made when the two layers of the pericardium rub against each other. The diagnosis is confirmed by tests to check for signs of inflammation, fluid around the heart in the pericardium or infection.
Additional diagnostic procedures are used to identify and rule out other causes that may contribute to your symptoms:
Pericarditis that is not causing significant symptoms is often treated with a watch-and-wait approach. This is especially appropriate if the inflammation is viral. Many cases of pericarditis require treatment with anti-inflammatory and/or pain-relieving medications.
Cardiac tamponade is a serious complication of pericarditis caused by fluid buildup around the heart and requires a procedure called pericardiocentesis, to drain excess fluid from the pericardial cavity. This allows evaluation for infection and, if the cause is found to be a bacterial infection, antibiotics are used.
Surgical removal of the pericardium (pericardectomy) may be needed if severe or chronic pericarditis has caused the pericardium to become rigid and restrict the heart’s pumping action.