Pericarditis is a disorder caused by inflammation (swelling and irritation with presence of extra immune cells) of the pericardium, which is the sac-like covering of the heart.

Causes, incidence, and risk factors

Pericarditis is usually a complication of viral infections caused by adenovirus and coxsackie virus. Less frequently, it can be caused by the polio , influenza or rubella viruses. Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal (mycotic) infections can also produce pericarditis. In addition, pericarditis can be associated with systemic diseases such as autoimmune disorders , rheumatic fever , tuberculosis , cancer , leukemia , kidney failure , HIV infections, AIDS and hypothyroidism. Heart disorders which can cause pericarditis include heart attack ( post-MI pericarditis ) and myocarditis . Radiation therapy to the chest and medications that suppress the immune system can also sometimes induce this condition. Pericarditis can also result from injury (including surgery) or trauma to the chest, esophagus or heart. Quite often, the cause of pericarditis remains unknown; this disorder is called idiopathic pericarditis. Pericarditis most often affects men ages 20 to 50, usually following respiratory infections. It can also occur in children, where it is most commonly caused by adenovirus or coxsackie virus.

Signs and tests

When listening to the heart with a stethoscope, the health care provider can hear a typical 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 , or other signs of fluid in the space around the lungs ( pleural effusion ). If fluid has accumulated in the pericardial sac, it may show on:

Chest X-ray

Echocardiogram

Chest MRI scan

Heart MRI

or heart

CT scan

Radionuclide scanning

These tests show enlargement of the heart from fluid collection in the pericardium, and signs of inflammation. They may also show scarring and contracture of the pericardium ( constrictive pericarditis ). Other findings vary depending on the cause of pericarditis. An ECG is abnormal in 90% of patients with acute pericarditis. The ECG changes generally evolve in stages during the disease process, and they may mimic the ECG changes of a heart attack . To rule out heart attack, serial cardiac marker levels ( CK -MB and troponin I) may be ordered. Other laboratory tests may include:

blood culture

CBC

, may show increased

WBC count

C-reactive protein

erythrocyte sedimentation rate (ESR)

pericardiocentesis

with chemical analysis and

pericardial fluid culture

Treatment

The cause of pericarditis must be identified, if possible. In most types of pericarditis, it is necessary to treat the pain with analgesics (pain killers). The inflammation of the pericardium is treated with anti-inflammatory drugs(NSAIDS) such as aspirin and ibuprofen; in some cases, corticosteroids may be prescribed. Diuretics may be used to remove excess fluid accumulated in the pericardial sac. If the pericardial fluid collection compromises the heart function or produces cardiac tamponade, it is necessary to drain the fluid through pericardiocentesis (removal of excess fluid from the pericardial sac). Pericardiocentesis may be either percutaneous (using a needle to reach the pericardium, guided with echocardiography, in the procedure room), or surgical (done in the operating room as a minor surgery). Bacterial pericarditis should be treated with antibiotics, and fungal pericarditis, with antifungal agents. If the pericarditis is chronic , recurrent, or results in constrictive pericarditis , it may be advisable to perform pericardiectomy (cutting or removal of part of the pericardium).

Expectations (prognosis)

Pericarditis can range from mild cases that resolve on their own, to life threatening cases complicated by significant fluid buildup around the heart and poor cardiac output. The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months.

Complications

Arrhythmias, such as atrial fibrillation. When pericarditis accompanies myocarditis, other arrhythmias may be present, such as supraventricular tachycardia (SVT) or complete heart block.

Cardiac tamponade

Constrictive pericarditis

, where inflammation of the pericardial sac results in fibrosis and thickening of the pericardium with adhesions (i.e., sticky scars) between the pericardium and the heart. The pericardium creates a rigid "case" around the heart and can severly limit the ability of the heart to fill with blood during diastole (i.e., the relaxation phase before the next heartbeat). Patients with constrictive pericarditis may develop

heart failure which responds poorly to treatment. Constrictive pericarditis needs to be differentiated from a chronic heart condition called restrictive cardiomyopathy , which produces symptoms and signs similar to constrictive pericarditis.

Calling your health care provider

Call your health care provider if symptoms indicate pericarditis may be present. The disorder can be life threatening if untreated.

Prevention

Many cases may not be preventable. Treat respiratory infections and other disorders promptly.