Pericarditis is irritation and swelling of the sac that surrounds the heart. The sac, called the pericardium, is made up of two thin layers and a small amount of fluid that sits between the layers. Since the sac surrounds the heart, swelling of the sac can make it difficult for the heart to work properly.
The cause of pericarditis is often unknown. Potential causes include:
- Viral, bacterial, or fungal infection—most common known cause
- Heart attack
- Inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus
- Cancer that has spread from a tumor near the heart
- Kidney failure
- Injury or surgery affecting the chest, esophagus, or heart
- Radiation treatment
- Certain medications used to suppress the immune system
A common symptom of pericarditis is a sharp, stabbing chest pain. The pain is often over the left side or center of the chest and may spread to the neck and shoulders. Deep breathing or lying down may worsen the pain and sitting up may lessen it.
Other symptoms may include:
- Shortness of breath
- Fever and chills
- Pain when swallowing
- Weakness and fatigue
- Feeling abnormal heartbeats
The doctor will ask about your pain, other symptoms, and medical history. A physical exam will be done including listening to the heart or lungs for abnormal sounds. The swollen layers can rub against the heart and create a unique sound that can be heard with a stethoscope. To confirm the diagnosis and determine the severity of the condition, images of the heart and chest may be taken with:
- Chest x-ray—includes images of the lung
- Electrocardiogram (EKG)—shows the electrical activity of the heart
- Echocardiogram—shows how well the heart muscle is working
- MRI scan or CT scan—detailed images of tissue in the chest
Bodily fluids may also need to be tested to look for infections. Fluids may be found through:
- Blood tests
- Pericardiocentesis—fluid from around the heart is removed for testing
The main goals of treatment are to relieve pain and swelling and treat any underlying causes. If an infection is present an antibiotic or other medication may be recommended.
Rest, over-the-counter pain medications, and monitoring may be all that is needed for mild pericarditis. The inflammation usually passes within a few weeks or months.
Pericarditis can also be an emergency situation. More severe pericarditis may need advance treatment and hospitalization to manage complications. If the swelling is making it difficult for the heart to beat, fluid may need to be removed. A procedure called pericardiocentesis removes the fluid with a needle. In rare cases, surgery may be done to open the sac to relieve pressure on the heart.
Some types of pericarditis are caused by chronic inflammatory diseases, like systemic lupus erythematosus or rheumatoid arthritis. These forms of pericarditis may last longer or tend to recur. A treatment plan will be created to help decrease the risk of future incidents.
- Reviewer: Michael J. Fucci, DO
- Review Date: 12/2016 -
- Update Date: 12/20/2014 -