Pericarditis – Causes, Symptoms, Diagnosis, Treatment, Medications

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed. A characteristics chest pain is often present. The hearts sits in the center of the chest and is surrounded by a sac called the pericardium. This sac has two layers, one that fits tightly onto the heart muscle and another looser layer surrounding the inner layer. Inflammation of these tissue layers surrounding the heart is referred to as pericarditis.

Causes of Pericarditis

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection. Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal infections can also produce pericarditis. There are many causes of pericarditis. Most often the cause is unknown. In this case, the condition is called idiopathic pericarditis.

The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precordium (for i.e. Mycobacterium tuberculosis), post-infarct pericarditis (pericarditis due to heart attack), or Dressler’s pericarditis.

Other causes include:

  • Heart attack (see post-MI pericarditis)
  • Injury (including surgery) or trauma to the chest, esophagus, or heart
  • Medications that suppress the immune system
  • Myocarditis
  • Radiation therapy to the chest

Pericarditis most often affects men aged 20 – 50. It usually follows respiratory infections. In children, it is most commonly caused by adenovirus or coxsackie virus.

Symptoms of Pericarditis

  • Ankle, Feet, and Leg Swelling (occasionally)
  • Anxiety
  • Breathing difficulty when lying down
  • Chest pain, caused by the inflamed pericardium rubbing against the heart
  • May radiate to the neck, shoulder, back, or abdomen
  • Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
  • Pleuritis type: a sharp, stabling pain
  • Usually relieved by sitting up and leaning forward
  • Dry Cough
  • Fatigue
  • Fever

Some symptoms may depend upon where the inflammation may be in the heart lining.

  • There may be pain with deep breaths and shortness of breath because of that pain, if there is inflammation in the pericardium near lung tissue.
  • Pain may occur with swallowing if the inflammation is near the esophagus.
  • Other symptoms depend upon the specific cause of the pericarditis. For example, infections may present with fever, chills and other non-specific symptoms such as muscle aches and general malaise.

Diagnosis of Pericarditis

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

  • Crackles in the lungs
  • Decreased breath sounds
  • Other signs of fluid in the space around the lungs ( pleural effusion)

The electrocardiogram (EKG or ECG) shows electrical activity of the heart. In pericarditis, there are often abnormalities that sometimes can help with the diagnosis. Unfortunately, many normal variants can mimic the changes in pericarditis or the EKG may be normal.

A chest x-ray may suggest enlargement of heart tissue and can be used to rule out other problems within the chest.

Echocardiography or ultra sound the heart is often used to confirm the diagnosis. The cardiologist looks for the presence of fluid in the pericardial sac, although in many mild cases of acute pericarditis, there is no pericardial fluid seen with echocardiography.

Blood testing can be used to look for specific causes of pericarditis like infection, leukemia, kidney failure, connective tissue diseases or thyroid abnormalities.

Treatment of Pericarditis

The cause of pericarditis must be identified, if possible.

Medications include:

  • Analgesic for pain
  • Antibiotics for bacterial pericarditis
  • Antifungal medications for fungal pericarditis
  • Aspirin or a no steroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
  • Corticosteroids such as prednisone (in some patients)
  • Colchicine