Disease: Pericarditis

    Pericarditis facts

    • Pericarditis is an inflammation of the lining surrounding the heart (the pericardial sac).
    • Pericardial effusion is a collection of fluid in the pericardial sac. This fluid may be produced by inflammation.
    • The cause of pericarditis in most individuals is unknown but is likely due to viral infection. Pericarditis may be an associated complication of many diseases or may be due to trauma.
    • The diagnosis of pericarditis is made by history and physical examination. Testing usually includes an electrocardiogram (EKG, ECG), chest X-ray, and echocardiogram, or ultrasound of the heart. The inflammation of pericarditis is usually treated with anti-inflammatory medications (such as ibuprofen). It is important to treat the underlying disease or illness if one is present.
    • Pericardial tamponade occurs when enough fluid accumulates in the sac to compromise the heart's ability to adequately pump blood.
    • Tamponade is a medical emergency and is treated by pericardiocentesis, inserting a needle into the pericardial sac to remove the fluid.

    What is pericarditis?

    The heart muscle has a tight covering that surrounds it, a lining sac called the pericardium (peri=around +cardium=heart). This sac actually has two layers. The visceral pericardium is only one cell layer thick and fits tightly onto the heart muscle. The parietal pericardium is much tougher and thicker and has fibers that tether the heart to the rib cage and diaphragm. There is a potential space between the layers, meaning that in normal situations, it has a minimal amount of fluid. However, should inflammation occur, it can fill with fluid. Inflammation of the lining of the heart is called pericarditis (itis=inflammation).

    Picture of the heart in the pericardial sac.

    What causes pericarditis?

    Pericarditis is usually from unknown causes (idiopathic). The cause may often be viral infections. Causes of pericarditis include:

    Infections:

    • Viruses
    • Bacteria (like tuberculosis)
    • HIV (human immunodeficiency virus)

    Inflammatory diseases:

    Diseases that can cause generalized inflammation in other places within the body can also cause inflammation of the pericardium. Some examples include:

    • Rheumatoid arthritis
    • Systemic lupus erythematosus (SLE)
    • Scleroderma
    • Ankylosing spondylitis
    • Inflammatory bowel disease

    Metabolic illnesses:

    • Kidney failure and uremia
    • Hypothyroidism

    Heart disease:

    • Heart attack can cause direct irritation and inflammation of the pericardial lining.
    • Dressler's syndrome describes inflammation caused by an immune response to heart tissue damage from heart attack, open heart surgery, or a trauma.

    Other causes:

    • Tumors
    • Radiation therapy
    • Medications

    What are the symptoms of pericarditis?

    Chest pain is the most common symptom of pericarditis.

    • Classically, the pain is begins in the center of the chest and radiates to the neck or upper back.
    • The pain is sharp and stabbing, but may also be felt as a dull, ache or burning pain.
    • The intensity may be mild or very severe and it can come on gradually or suddenly.
    • The pain makes it hurt to take a breath.
    • Most individuals feel worse when lying flat.

    Other symptoms may include fevers and chills, sweats, shortness of breath, and difficulty swallowing.

    When pericarditis is due to infection, the symptoms tend to arise quickly while inflammation due to chronic diseases is more gradual in onset.

    How is pericarditis diagnosed?

    History and physical examination

    The diagnosis of pericarditis begins with the health care professional taking a history about the pain and its character. The health-care professional will perform a physical examination and ask the patient about associated symptoms. Past medical history is important, since pericarditis can be a complication of a chronic disease or a side effect of medication.

    The most common physical finding that helps confirm the diagnosis of pericarditis is a pericardial friction rub. Inflammation prevents the two layers of pericardium from easily sliding against each other with each heartbeat. The inflammation causes a friction noise that can be heard with a stethoscope when listening to the heart. It is better heard when the patient leans forward, which causes the heart to shift to the front of the chest. The rub may not always be present and may come and go from hour to hour.

    Diagnostic testing

    The electrocardiogram (EKG or ECG) shows electrical activity of the heart. In pericarditis, there are hallmark changes that are seen and can help make the diagnosis. While an abnormal EKG is helpful in making the diagnosis, in the early stages of inflammation, the EKG may be normal. In most cases of uncomplicated pericarditis, a chest X-ray is usually normal. However, if fluid accumulates in the pericardial sac, the heart can appear larger on the X-ray.

    A sound wave test of the heart (an echocardiogram or ultrasound of the heart) is very helpful in detecting and quantifying the fluid in pericarditis. The purpose of the test is to detect an accumulation of fluid in the pericardial sac, called an effusion. Although in many mild cases of acute pericarditis, there is no pericardial fluid seen with echocardiography. A variety of blood tests may be ordered depending upon the clinical situation.

    Pericardiocentesis (please see below), is a procedure using a needle, is used to draw fluid out of the pericardial sac. It may be done to detect bacterial infection. This procedure can also be used to treat dangerous, severe pericarditis called pericardial tamponade.

    What causes pericarditis?

    Pericarditis is usually from unknown causes (idiopathic). The cause may often be viral infections. Causes of pericarditis include:

    Infections:

    • Viruses
    • Bacteria (like tuberculosis)
    • HIV (human immunodeficiency virus)

    Inflammatory diseases:

    Diseases that can cause generalized inflammation in other places within the body can also cause inflammation of the pericardium. Some examples include:

    • Rheumatoid arthritis
    • Systemic lupus erythematosus (SLE)
    • Scleroderma
    • Ankylosing spondylitis
    • Inflammatory bowel disease

    Metabolic illnesses:

    • Kidney failure and uremia
    • Hypothyroidism

    Heart disease:

    • Heart attack can cause direct irritation and inflammation of the pericardial lining.
    • Dressler's syndrome describes inflammation caused by an immune response to heart tissue damage from heart attack, open heart surgery, or a trauma.

    Other causes:

    • Tumors
    • Radiation therapy
    • Medications

    What are the symptoms of pericarditis?

    Chest pain is the most common symptom of pericarditis.

    • Classically, the pain is begins in the center of the chest and radiates to the neck or upper back.
    • The pain is sharp and stabbing, but may also be felt as a dull, ache or burning pain.
    • The intensity may be mild or very severe and it can come on gradually or suddenly.
    • The pain makes it hurt to take a breath.
    • Most individuals feel worse when lying flat.

    Other symptoms may include fevers and chills, sweats, shortness of breath, and difficulty swallowing.

    When pericarditis is due to infection, the symptoms tend to arise quickly while inflammation due to chronic diseases is more gradual in onset.

    How is pericarditis diagnosed?

    History and physical examination

    The diagnosis of pericarditis begins with the health care professional taking a history about the pain and its character. The health-care professional will perform a physical examination and ask the patient about associated symptoms. Past medical history is important, since pericarditis can be a complication of a chronic disease or a side effect of medication.

    The most common physical finding that helps confirm the diagnosis of pericarditis is a pericardial friction rub. Inflammation prevents the two layers of pericardium from easily sliding against each other with each heartbeat. The inflammation causes a friction noise that can be heard with a stethoscope when listening to the heart. It is better heard when the patient leans forward, which causes the heart to shift to the front of the chest. The rub may not always be present and may come and go from hour to hour.

    Diagnostic testing

    The electrocardiogram (EKG or ECG) shows electrical activity of the heart. In pericarditis, there are hallmark changes that are seen and can help make the diagnosis. While an abnormal EKG is helpful in making the diagnosis, in the early stages of inflammation, the EKG may be normal. In most cases of uncomplicated pericarditis, a chest X-ray is usually normal. However, if fluid accumulates in the pericardial sac, the heart can appear larger on the X-ray.

    A sound wave test of the heart (an echocardiogram or ultrasound of the heart) is very helpful in detecting and quantifying the fluid in pericarditis. The purpose of the test is to detect an accumulation of fluid in the pericardial sac, called an effusion. Although in many mild cases of acute pericarditis, there is no pericardial fluid seen with echocardiography. A variety of blood tests may be ordered depending upon the clinical situation.

    Pericardiocentesis (please see below), is a procedure using a needle, is used to draw fluid out of the pericardial sac. It may be done to detect bacterial infection. This procedure can also be used to treat dangerous, severe pericarditis called pericardial tamponade.

    Source: http://www.rxlist.com

    Pericarditis is usually from unknown causes (idiopathic). The cause may often be viral infections. Causes of pericarditis include:

    Infections:

    • Viruses
    • Bacteria (like tuberculosis)
    • HIV (human immunodeficiency virus)

    Inflammatory diseases:

    Diseases that can cause generalized inflammation in other places within the body can also cause inflammation of the pericardium. Some examples include:

    • Rheumatoid arthritis
    • Systemic lupus erythematosus (SLE)
    • Scleroderma
    • Ankylosing spondylitis
    • Inflammatory bowel disease

    Metabolic illnesses:

    • Kidney failure and uremia
    • Hypothyroidism

    Heart disease:

    • Heart attack can cause direct irritation and inflammation of the pericardial lining.
    • Dressler's syndrome describes inflammation caused by an immune response to heart tissue damage from heart attack, open heart surgery, or a trauma.

    Other causes:

    • Tumors
    • Radiation therapy
    • Medications

      Source: http://www.rxlist.com

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