Pericarditis

Pericarditis is a condition in which the fluid-filled sac surrounding the heart – the pericardium – swells.  It is not usually a serious condition.

Pericarditis can be categorized into 3 main types:

• Acute Pericarditis, where symptoms last less than 3 months
• Recurring Pericarditis, consisting of repeated episodes of acute pericarditis
• Chronic Pericarditis, where symptoms last more than 3 months.

Incidence; Causes and Development

Pericarditis is a common heart condition, with approximately 1-in-20 people who visit the Emergency Room with severe chest pain being diagnosed with it.

The exact cause of pericarditis is usually unknown, but is often suspected to be a viral infection, which is hard to confirm.  Viral infections that can cause pericarditis include common cold or flu viruses, meningitis, pneumonia, bronchitis, glandular fever, cytomegalovirus, herpes simplex, hepatitis C, and HIV/AIDS.

Other possible causes include chest trauma (for example after a serious car accident or heart surgery), bacterial infection (especially tuberculosis), autoimmune disease, kidney failure, hypothyroidism, cancers such as breast or lung cancer, some cancer treatments (radiotherapy, chemotherapy), and side-effects of other medications such as penicillin.

Pericarditis can also occur after a heart attack, when damaged heart muscles irritate the pericardium.

Signs and Symptoms

The main symptom of pericarditis is chest pain, which can range from a dull ache or 'pressure' in some cases to (more commonly) a sudden, sharp, stabbing pain behind the left side of the breastbone.  The pain often worsens when lying down, coughing, laughing, eating, or breathing in.  This pain may radiate into the neck and left shoulder.

Depending on the underlying cause, the following symptoms may also be present:

• fever
• shortness of breath
• fatigue
• nausea
• a dry cough
• edema of the legs or abdomen

Diagnosis and Tests

Pericarditis can present as a distinctive 'rasping' or 'grating' heartbeat sound when listened to through a stethoscope.  Blood tests can confirm or rule out infections, and also check liver and kidney function.  A needle may be used to drain a specimen of fluid from around the heart for examination.  When pericarditis is strongly suspected, the diagnosis is usually confirmed by ECG, which will detect any unusual electrical patterns of the heart.

If further testing is required, it may involve a chest X-ray, MRI scan, CT scan, and/or echocardiogram (this can check for signs of cardiac tamponade.)

Treatment and Prevention

With treatment, symptoms normally resolve within a week.  Hospitalization may be required in high-risk cases.  Treatment depends on the type of pericarditis:

• Acute Pericarditis: Reducing the swelling with NSAIDs (Ibuprofen) is usually sufficient, unless the patient has recently suffered a heart attack, in which case a high-dose aspirin can be used instead.  Those failing to respond to NSAIDs can be treated with colchicine.  Antibiotics are also used if bacterial infection is present.  Those treated with steroids (corticosteroids) are 500% more likely to develop recurring pericarditis, so steroids are now considered a drug treatment of last resort.
• Recurring Pericarditis can be prevented with colchicine
• Chronic Pericarditis: The decision whether to use medication or surgery depends on the underlying cause.

In patients with very severe symptoms which do not respond to medications, a pericardiectomy may be necessary.  This is a major surgical procedure in which some or all of the pericardium is removed.  Unfortunately this is a risky procedure, with a fatality rate of roughly 1-in-20.

Complications; Seek medical attention if...

A rare but life-threatening complication of pericarditis is cardiac tamponade, in which excess build-up of fluid inside the pericardium puts pressure on the heart, making it unable to beat properly.

Cardiac tamponade also often occurs alongside inflammation of the heart muscle (myocarditis).  This causes pain that feels like pressure on the chest, similar to a heart attack.

Sudden chest pain should always be treated as a medical emergency.  Symptoms of cardiac tamponade (a serious complication of pericarditis) include:

• light-headedness
• blurred vision
• heart palpitations
• nausea

Those with a history of pericarditis who experience any of the above symptoms should seek immediate medical attention.