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Pericarditis
 The
pericardium is a thin fibrous membrane sac that surrounds the heart. The
pericardium consists of:
- An inner layer
(visceral pericardium) – envelopes the entire heart
- An outer layer
(parietal pericardium) – the outer fibrous sac
- A middle fluid
layer – a small amount of fluid lies between the two layers to prevent
friction between the two surfaces.
Pericarditis is inflammation
of any of the layers of the pericardium.
Pericarditis can be
caused by:
- After heart surgery
- Infections
- After a heart attack
- Trauma
- Tumors
- Cancer
- Radiation
- Auto-immune diseases
(such as rheumatoid arthritis, lupus, or scleroderma)
- No cause may be
found
It can be acute (occurring
suddenly) or chronic (occur over time).
Symptoms of Pericarditis
may include any of the following:
- Chest pain: this
pain is different from angina (pain caused by coronary artery disease).
It may be sharp and located in the center of the chest. The pain may
radiate to the neck and occasionally, arms and back. It is made worse
when lying down, coughing or swallowing and relieved by sitting forward.
- Low-grade fever
- Increase in heart-rate
- No symptoms may
be present
Diagnosis is based
on:
- Symptoms
- EKG (electrocardiogram)
changes
- Physical exam
– the doctor will hear a sound, with his stethoscope, as the inflamed
layers of the heart rub together
- Other tests may
be done to determine the cause of the pericarditis
Treatment is based
on the cause and may include:
- Non-steroidal anti-inflammatory
agents (NSAIDS) are used to decrease the pain and inflammation.
- Occasionally steroids
are used for severe attacks.
- Antibiotics if
the pericarditis is due to infection.
Most patients recover
in two to four weeks.
Constrictive Pericarditis
In severe pericarditis,
the layers of the pericardium may become stiff and stick together. This
prevents the heart muscle from expanding during filling and impacts on
the function of the heart.
The symptoms include
the same as pericarditis with the addition of:
Diagnostic testing
may also include the echocardiogram, cardiac catheterization,
MRI, or CT scan.
Treatment of constrictive
pericarditis include:
- Analgesics and
anti-inflammatory agents to treat pain or inflammation
- Diuretics to treat
heart failure symptoms
- Anti-arrhythmics
if necessary, to treat any heart arrhythmias, such as atrial fibrillation
- Pericardiectomy
– in some cases, the stiff pericardium may need to be removed from the
heart during heart surgery.
Resources:
Klein, AL, Scalia
GM (1998) Diseases of the Pericardium, Restrictive Cardiomyopathy and
Diastolic Dysfunction. In (E. Topol ed.) Textbook of Cardiovascular
Medicine, Lippincott-Raven: Philadelphia, pp.639-705.
Conditions A-Z, Pericarditis,
http://onhealth.com/conditions*
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new browser window will open with this link. The inclusion of links to
other web sites does not imply any endorsement of the material on the
web sites or any association with their operators
©Cleveland
Clinic Foundation, revised 1/02
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