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Pericarditis

Last updated Dec. 16, 2018

Approved by: Krish Tangella MD, MBA, FCAP

DoveMed.com

Microscopic pathology image of pericardium showing pericarditis.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Pericardial Inflammation

What is Pericarditis? (Definition/Background Information)

  • Pericarditis refers to swelling and inflammation of the pericardium, a sac-like layer that covers the heart. The pericardium contains a fluid that keeps the heart muscle moist and ensures a smooth function
  • When this sac becomes inflamed due to an underlying condition, the resulting friction between the membrane and muscle causes a stabbing chest pain, and results in Pericarditis. The actual site of infection origin may be in another area of the body, as a result of which complications can arise and affect the pericardium
  • In general, Pericarditis can be caused by a variety of infectious and non-infectious agents. The different types of Pericarditis may include:
    • Infectious Pericarditis, which may be due to bacteria, virus, or fungi. Most Pericarditis cases are of the infectious type
    • Non-Infectious Pericarditis, which may be due to autoimmune disorders, certain kidney conditions (including kidney failure), surgical procedures to the chest, use of certain drugs, etc.
  • The treatment of Pericarditis primarily involves treating the underlying cause of the condition. The prognosis depends on many factors, although in most cases with appropriate treatment, it is good
  • Pericarditis, in some cases, can become a chronic issue. However, in a majority of the individuals Pericarditis is generally short-lived

Pericarditis may be also classified into the following types:

  • Acute Pericarditis: It may develop within 7-10 days, but does not last for a long period of time. However, recurrences may be common with acute forms of Pericarditis
  • Chronic Pericarditis: It develops slowly over a period of time (greater than 10 days), and may last for a longer period of time

Who gets Pericarditis? (Age and Sex Distribution)

  • Pericarditis is more common in individuals in the 20-50 year age group, but it depends upon the type of Pericarditis
  • Both males and females may be affected
  • No racial, ethnic, or geographical preferences are seen

What are the Risk Factors for Pericarditis? (Predisposing Factors)

The risk factors for Pericarditis may include the following:

  • A previous diagnosis of acute Pericarditis may increase the risk
  • If the immune system is already weakened due to HIV, cancer, or any other such conditions, then the possibility is higher
  • Non-infectious agents may include systemic lupus erythematosus, acute kidney failure, heart attack, leukemia, connective tissue and other genetic disorders, etc.
  • Any condition causing increased blood urea nitrogen levels in the body may result in Uremic Pericarditis
  • Certain medications are known to induce Pericarditis, in which case it is called Drug-Induced Pericarditis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pericarditis? (Etiology)

  • Pericarditis may occur due infection by microorganisms such as a virus, bacteria, or fungi
  • Sometimes, an underlying disorder (like an autoimmune disorder) may cause inflammation of the pericardium
  • In majority of the cases, the cause of Pericarditis remains unidentified (Idiopathic Pericarditis)

What are the Signs and Symptoms of Pericarditis?

The signs and symptoms of Pericarditis include, but are not limited to, the following:

  • Low-grade fever, chills, sweating
  • Chest pain; pain in chest increases on coughing or swallowing
  • Dry cough
  • Fatigue, anxiety
  • Difficulty breathing, which gets worse especially while reclining or lying down, but gets better on sitting, leaning forward or standing
  • Rapid heart rate, heart palpitations
  • Pain in the back
  • Swelling of the legs and feet (edema)
  • Signs and symptoms of the underlying condition

How is Pericarditis Diagnosed?

A diagnosis of Pericarditis may be made as follows:

  • A thorough physical examination with a complete medical history
  • If symptoms are noted, the healthcare provider may need a full medical history to correlate the condition and rule out other possible causes of infection
  • A stethoscope is used to listen to the heartbeat; if a faint sound is heard, it can usually raise suspicion/concern for the healthcare provider

A series of tests to view structures and fluid present in the heart may then be ordered, for further observation of the infection. These tests may include:

  • Blood test to determine underlying disorder
  • Blood culture to determine the causative organism, if bacterial or fungal infection is suspected
  • X-ray of chest
  • CT or MRI scan of the chest
  • Echocardiogram

The radiology imaging tests may show the presence of any abnormal fluid levels around the heart, within the pericardial sac.

  • Sometimes, depending on the clinical situation, abnormal fluid in the pericardial sac may be cultured, to show which specific organism is responsible for the infection
  • The fluid is collected by aspiration through a procedure called pericardiocentisis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pericarditis?

The following complications may occur due to Pericarditis:

  • Constrictive pericarditis, a condition wherein the heart function is restricted, due to compression by the surrounding pericardial sac
  • Swelling of the lungs (pulmonary edema)
  • Cardiac tamponade (accumulation of excess fluid)
  • Shock: A condition which can result in failure of vital organs in the body
  • Complications due to the underlying condition
  • The condition may recur (recurrent pericarditis) or last for many years (chronic pericarditis)

How is Pericarditis Treated?

The underlying condition must be treated, in order to effectively control and cure pericarditis. The treatment of Pericarditis may include the following measures:

  • The use of medications to kill the pathogens and manage pain such as:
    • Antibiotics (to kill the bacteria), antivirals (to kill viruses), and antifungal medications (to kill fungi)
    • Analgesics (to relieve pain)
    • Anti-inflammatory medication (to decrease inflammation)
  • Plenty of rest (bed rest) will be recommended as well
  • If there is a severe buildup of fluid, a small cut is made in the pericardium, to allow drainage of the fluid. This procedure is called pericardiocentesis
  • Additionally, diuretics to help decrease excess fluid accumulation in the body, may be administered
  • The treatment for recurrent pericarditis (arising from acute pericarditis) is using colchicine medication

How can Pericarditis be Prevented?

A few preventative tips for Pericarditis may include:

  • Maintaining a healthy lifestyle and diet can help minimize the chances of contracting infections
  • Undertaking proper treatment of underlying autoimmune conditions and other disorders
  • Ensure that open wounds/cuts are cleaned and covered, to prevent pathogens from entering the body
  • If an individual has a weakened immune system, then appropriate treatment to boost the immune system can help prevent Pericarditis

What is the Prognosis of Pericarditis? (Outcomes/Resolutions)

  • Pericarditis can lead to life-threatening symptoms, if the condition is left untreated. The prognosis also depends on the severity of the signs and symptoms of the underlying condition
  • If the condition is diagnosed early and treated effectively, the affected individuals typically make a full recovery

Additional and Relevant Useful Information for Pericarditis:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/common-procedures/procedures-laboratory/pericardial-fluid-analysis/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 19, 2016
Last updated: Dec. 16, 2018