Pericarditis

WHAT YOU SHOULD KNOW

Pericarditis is an inflammation of the sac surrounding the heart (the pericardium). It is often accompanied by a fluid buildup inside the sac, or a thickening or stiffening of its walls. In either case, the condition can constrict the heart, limiting its capacity to fill with blood and thus reducing its ability to pump blood.

Causes

Pericarditis can result from a number of problems. A bacterial, fungal, or viral infection, such as bacterial pneumonia, tuberculosis, rubella, or rheumatic fever, is often the cause. HIV infection and AIDS increase the chances of this disorder. It can also stem from noninfectious diseases such as lupus, rheumatoid arthritis, cancer, and chronic kidney failure. It sometimes follows a heart attack or an accident that damages the heart. Certain drugs, such as blood thinners or the seizure medication phenytoin, are other possible culprits Onset of the condition can be abrupt (in which case the problem is called acute pericarditis) or gradual and protracted (called chronic pericarditis).

Signs/Symptoms

The most common symptom of pericarditis is chest pain that extends into the left shoulder and increases when you lie down, cough, take a breath, or move your body. The pain may be sharp and stabbing, similar to that of a heart attack, but may be relieved by sitting up and leaning forward. Additional symptoms include shortness of breath, a low-grade fever, swelling of the veins in the neck, and fluid retention (edema) in the legs and abdomen.

Care

Any type of chest pain is a medical emergency. You should seek medical care immediately. If fluid buildup is putting dangerous pressure on the heart, the doctor will have to draw off the excess with a large syringe.

Once the situation is under control, you'll be given treatment for the underlying cause. For example, if the pericarditis stems from kidney failure, you will be put on dialysis, or if it is due to a bacterial infection, you will be given antibiotics. In mild cases with no symptoms and an undetectable cause, the doctor may simply monitor your condition.

Risks

Left untreated, pericarditis could further constrict the heart, leading to heart failure and death.

WHAT YOU SHOULD KNOW

THIS IS A MEDICAL EMERGENCY. If you suspect pericarditis, call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may experience the following procedures and equipment during your stay.

• Chest X-ray: This picture of the chest and lungs will show doctors whether fluid is accumulating in the pericardium.
• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• IV: A tube placed in your vein for giving medications, such as antibiotics to fight infection and liquids to replace lost fluids. It will either be capped or have tubing connected to it.
• Electrocardiogram: Also known as an ECG, EKG, or heart monitor, this test is conducted by placing electrodes, or patches, on your chest to measure the electrical currents in the heart. The patches are hooked up to a TV-type screen or small portable box that shows a tracing of each heartbeat.
• Echocardiogram: Also called an ECHO, this device uses sound waves to build an image of the heart and determine if fluid is accumulating around it. During the procedure, conductive jelly is applied to your chest and the device is pressed against it.
• Medicine: You will be given medicines to reduce the inflammation and relieve the pain.
  • Analgesics: To relieve pain.
  • Diuretics: To remove excess fluid.
  • Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids: To relieve inflammation of the pericardium.
• Pericardiocentesis: This is the procedure done to remove excess fluid from the pericardium. You may receive sedatives or tranquilizers prior to receiving the needle. The insertion site is shaved, cleaned with an antiseptic solution, and numbed with a local anesthetic. After the needle has drawn off the excess fluid, a bandage is placed over the insertion site.
• Surgery: In rare chronic cases, surgery is needed to remove the pericardium.

After You Leave

• Follow your doctor's orders regarding medications, activity, and follow-up appointments.
• Get plenty of bed rest with the head of the bed upright to decrease the workload on your heart. Complete recovery may take between two weeks and three months.

Seek Care Immediately If...

• You experience chest pain.
• You develop shortness of breath.
• You have palpitations.

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