Topic Overview
What is pericarditis?
Pericarditis is a swelling
and irritation of the
pericardium, which is the sac that surrounds your
heart.
What causes pericarditis?
Most of the time the
cause is either not known or is thought to be a viral infection.
Less common causes of pericarditis are a heart attack, a bacterial
infection, an injury to the chest, or radiation treatments for cancer. Kidney
failure,
HIV infection,
tuberculosis,
hypothyroidism, autoimmune diseases such as
lupus, or certain drugs may also cause pericarditis.
What are the symptoms?
The main symptom is a
sharp pain in the center of your chest or in the left side of your chest. This
pain may spread to the shoulder blade. For some people, this pain is dull
instead of sharp. The pain may be worse when you lie down or take a deep
breath.
The pain lasts for hours or days and does not get better
when you rest. It is different from a type of chest pain called
angina, which only lasts a short time and usually gets
better with rest.
Other symptoms may include a mild fever,
weakness, feeling very tired, coughing, hiccups, and muscle aches.
Pericarditis usually is not dangerous, but your chest pain could be
caused by something more serious, like a
heart attack. And getting diagnosed and treated early
can help keep pericarditis from leading to other problems. That’s why you
should call a doctor right away if you have any kind of sudden chest
pain.
Can complications of pericarditis develop?
Pericarditis usually does not cause serious problems. Most people get
better in 7 to 10 days. When there are problems, they may include:
- A buildup of fluid in the pericardial sac
(pericardial effusion).
See a picture of pericardial effusion.
- Sudden pressure on the heart and sudden
difficulty pumping enough blood (called
cardiac tamponade). This can be caused by the weight
and pressure of the fluid buildup if it happens quickly.
-
Constrictive pericarditis
, which can be caused by
pericarditis that comes back or lasts longer than normal. The sac around the
heart gets thick and stiff. This makes it harder for the heart to pump blood.
How is pericarditis diagnosed?
Your doctor will
listen to your heart during a physical exam. He or she will also ask questions
about your medical history, such as whether you've had a recent virus,
radiation treatment for cancer, or tuberculosis.
Your doctor may
want you to have several tests, including an
electrocardiogram, a chest X-ray, and blood
tests.
If the chest X-ray shows any fluid buildup, or if you have
symptoms that last more than 10 days, your doctor will want you to have a test
called an
echocardiogram.
How is it treated?
If there are no other problems,
pericarditis usually goes away on its own in a few weeks. Your doctor may
suggest pain relievers that you can buy without a prescription to help take
care of your pain or discomfort. In some cases, the doctor may prescribe
stronger medicine.
Frequently Asked Questions
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Symptoms
Symptoms of
pericarditis include:
- Chest pain. A sharp or dull constant pain often
develops. The pain may be located in the center of the chest and sometimes
extends over the left shoulder. Deep breathing, lying down, or swallowing may
make the pain worse. Sitting up and leaning forward may improve it.
- Mild fever.
- A general feeling of weakness, fatigue, or
lightheadedness.
- Shortness of
breath.
- Coughing.
- Hiccups.
- Muscle
aches.
The type of chest pain that occurs with pericarditis
differs from
angina, which usually becomes worse with exertion but
does not change with deep breathing. You should tell your doctor anytime you
have chest pain. In the early stages of pericarditis, it may be hard to tell
whether the pain is from the inflammation or from a possible
heart attack.
If you develop
complications of pericarditis, you are at risk for
sudden heart failure. Symptoms of sudden heart failure
include sudden severe shortness of breath, a sudden irregular or rapid
heartbeat, and a cough that brings up foamy pink mucus. Sudden heart failure is
a medical emergency that requires immediate care. If you
experience any symptoms of sudden heart failure, call 911 or quickly get other emergency medical help.
Exams and Tests
Medical history and physical exam
A physical exam
and a review of your medical history will help a doctor diagnose
pericarditis, its
complications, and any related conditions.
A doctor will ask questions about your symptoms and general health and
may ask whether you've had any flu-like symptoms recently and whether you've
ever had any serious infections, such as tuberculosis. Having had cancer,
radiation treatments for cancer, or significant injuries to the chest are also
important clues to help diagnose pericarditis.
Your doctor will
listen to your heart for a sound called a pericardial friction rub, which often
occurs with pericarditis. A pericardial friction rub sounds like Velcro being
pulled apart. A friction rub is thought to be caused by tissue membranes as
they rub together. Sometimes it is difficult to hear or recognize.
Electrocardiogram (EKG or ECG)
An inflamed
pericardium can affect your heart's regular electrical
impulses. An
electrocardiogram (EKG or ECG) can identify any
abnormal electrical activity.
Several electrocardiograms may be
done over a period of weeks to monitor the heart during the treatment of
pericarditis.
Chest X-ray
A
chest X-ray can show the size of your heart. Your
heart may look larger than normal if you have pericarditis. A chest X-ray can
also help your doctor find out whether you have other conditions, such as
tuberculosis or
pneumonia.
Echocardiogram
Echocardiogram (echo) is useful for diagnosing fluid
in the sac around the heart (pericardial effusion).
See a picture of pericardial effusion.
An echocardiogram is also used to check whether fluid is putting pressure on
the heart (pericardial tamponade) and whether there is stiffening
of the sac around the heart (constrictive pericarditis).
Blood tests
A variety of blood tests can help your
doctor find out whether you have inflammation somewhere in your body, including
the
pericardium, or whether you have another condition
that is causing the pericarditis.
Pericardiocentesis
Pericardiocentesis is a procedure that may be used if
you have fluid buildup in the pericardium (pericardial effusion).
During pericardiocentesis, a doctor numbs the skin on your
chest, inserts a needle and sometimes a thin tube called a catheter into the
area around the heart, and removes some fluid. This fluid can be sent to the
lab for testing to help determine the cause of pericarditis. Removing fluid
also relieves pressure on the heart.
Treatment Overview
Viral
pericarditis usually improves on its own with time.
Mild pain relievers may be all you need to relieve inflammation and control
pain. Bacterial pericarditis requires antibiotics in addition to pain
relievers.
Other conditions that may be the
cause of the pericarditis will also be treated.
If
complications develop and pressure on the heart (cardiac tamponade) is a concern, your doctor may need
to drain fluid from the pericardial sac.
Medicines
Aspirin, ibuprofen, and other
nonsteroidal anti-inflammatory drugs (NSAIDs) are
commonly used to reduce inflammation and relieve the pain of pericarditis.
Sometimes stronger medicines are also used for pain relief.
Another type of medicine called colchicine may be used to treat pericarditis
and prevent repeat (recurrent) episodes. Colchicine may be tried if other
medicines do not improve your pericarditis. Colchicine also reduces
inflammation, but it works differently than NSAIDs. Colchicine may be used
along with NSAIDs.
In rare cases, your doctor may prescribe
stronger anti-inflammatory medicines called
corticosteroids, such as prednisone. Corticosteroids
are usually used only for severe inflammation that does not respond to milder
medicines. In some cases, corticosteroids may make pericarditis worse.
If a bacterial infection is causing pericarditis, your doctor will
prescribe antibiotics to treat it.
Be sure to report to your
doctor any medicines that you are already taking. If you have pericarditis,
taking
anticoagulant medicines can cause bleeding into the
pericardial space (hemorrhagic pericardial effusion).
Medical procedures
Your doctor may drain excess
fluid buildup (pericardial effusion)
in the area between the pericardium and the heart in a
procedure called
pericardiocentesis. This procedure is also done to
reduce pressure (cardiac tamponade) around the heart.
Pericardiocentesis involves using a needle and sometimes a thin tube called a
catheter to drain the fluid. The need for pericardiocentesis is usually
determined by how well the heart is functioning. If fluid builds up gradually
and the heart is tolerating the increased fluid around it, treatment of the
cause may be tried first.
Constrictive pericarditis
Constrictive pericarditis
is a rare complication of pericarditis that can keep the
heart from pumping well. Some people develop shortness of breath, swollen legs
and feet, and other symptoms of
heart failure.
Your doctor may recommend
a low-sodium diet, medicines such as
diuretics to reduce your heart's workload, and limited
activity. If symptoms persist and are severe, you may need surgery to remove
the scarred part of the pericardial sac. This helps loosen the pericardium's
tight hold around the heart and allows the heart to pump more
effectively.
Home Treatment
As with any heart disease, it is
important to follow your doctor's advice for home treatment for
pericarditis and to watch for any signs of
complications or a return of pericarditis, especially
shortness of breath.
Get plenty of rest until you are feeling
better, especially if you have a fever. Avoid all strenuous activity that has
not been approved by your doctor. Also, it is vital that you take your
medicines, especially antibiotics, as directed and keep all follow-up
appointments with your doctor to monitor your recovery from an episode of
pericarditis.
Other Places To Get Help
Organizations
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American Heart Association (AHA)
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| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: |
1-800-AHA-USA1 (1-800-242-8721) |
| Web Address: |
www.americanheart.org |
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Call the American Heart Association (AHA) to find your
nearest local or state AHA group. AHA can provide brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support. AHA's Web site also has information on
physical activity, diet, and various heart-related conditions.
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National Heart, Lung, and Blood Institute
(NHLBI)
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| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: |
(301) 592-8573 |
| Fax: |
(240) 629-3246 |
| TDD: |
(240) 629-3255 |
| E-mail: |
nhlbiinfo@nhlbi.nih.gov |
| Web Address: |
www.nhlbi.nih.gov |
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The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
- Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
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Texas Heart Institute
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| P.O. Box 20345 |
| Houston, TX 77225-0345 |
| Phone: |
1-800-292-2221 (Heart Information Service hotline)
(832) 355-4011 (general line) |
| E-mail: |
his@heart.thi.tmc.edu (Heart Information Services) |
| Web Address: |
www.texasheartinstitute.org |
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The Texas Heart Institute's national telephone hotline is staffed
by medical professionals who can answer heart-related health questions. The Web
site provides information on a wide range of heart topics, including common
disorders and prevention programs.
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References
Other Works Consulted
- Hoit BD (2008). Pericardial disease. In V Fuster et
al., eds., Hurst's The Heart, 12th ed., pp. 1951–1974.
New York: McGraw-Hill Medical.
- LeWinter MM (2008). Pericardial diseases. In P Libby
et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., pp. 1829–1853. Philadelphia: Saunders
Elsevier.
- Maisch B, et al. (2004). Guidelines on the diagnosis
and management of pericardial diseases. Executive summary. European Heart Journal, 25(7): 587–610.
- Shafi S, Oh JK (2008). Diseases of the pericardium,
cardiac tumors, and cardiac trauma. In DC Dale, DD Federman, eds.,
ACP Medicine, section 1, chapter 13. Hamilton, ON: BC
Decker.
Credits
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Author
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Robin Parks, MS |
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Editor
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Kathleen M. Ariss, MS |
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Associate Editor
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Pat Truman, MATC |
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Primary Medical Reviewer
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Caroline S. Rhoads, MD - Internal Medicine |
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Specialist Medical Reviewer
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John A. McPherson, MD, FACC, FSCAI - Cardiology |
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Last Updated
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April 20, 2009 |
