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Pericarditis

pericarditis

The pericardium is a thin sac-like tissue that covers the outer surface of the heart. It helps to anchor the heart in place, and prevents the heart from moving in the chest when you move. The pericardium has an inner and outer layer. There is a thin layer of 'lubricating' fluid between the two layers.

Pericarditis means inflammation of the pericardium.

What are the causes of pericarditis?
  • Viral infection
  • Several different viruses can cause pericarditis, including: Coxsackie viruses, echoviruses, influenza viruses, adenoviruses, the mumps virus, human immunodeficiency virus (HIV) and viruses that cause hepatitis.

    Other causes: Other causes are uncommon and include:

  • Infection with a bacterium.
  • Tuberculosis (TB) infection.
  • Uraemic pericarditis. This is inflammation caused by waste products building up in the bloodstream in people with untreated kidney failure.
  • Heart attack (myocardial infarction). Inflammation of the pericardium may occur if there is damage to nearby heart tissue, caused by a heart attack.
  • Following injury. For example, following a stab wound, or a severe blow to the chest.
  • Inflammatory diseases which can affect various parts of the body may include inflammation of the pericardium. For example: rheumatoid arthritis, scleroderma, polyarteritis nodosa, and systemic lupus erythematosus (SLE), also known as 'lupus'.
  • Radiotherapy to treat cancers in the chest.
  • Cancer which has spread to the pericardium from another part of the body.
  • Idiopathic pericarditis

In many cases, no cause can be found. This is called idiopathic pericarditis.

What are the symptoms of pericarditis?

The typical symptoms are chest pain and fever. The pain is usually in the middle of the chest or slightly left of centre. Typically, the pain gets worse if you take a deep breath, swallow, cough, or lie down. The pain may ease if you sit up or lean forward.You may also feel breathless, especially if tamponade develops.

What are the possible complications of pericarditis?

Complications are uncommon. They include the following:

  • Build-up of fluid
  • In many cases of pericarditis a small amount of fluid builds up between the two layers of the pericardium. This is called a pericardial effusion. A small amount of fluid is no problem and usually goes when the inflammation settles. However, sometimes a lot of fluid builds up and can press on the heart. This can prevent the heart chambers from filling normally, and prevents the heart from pumping blood properly. This is called cardiac tamponade and is a life-threatening problem unless the fluid is quickly drained.

  • Constrictive pericarditis
  • This is an uncommon condition that may develop if the pericardium has been inflamed for a long time. The pericardium thickens and contracts around the heart. This is serious as it can interfere with the function of the heart.

How is pericarditis diagnosed?
  • When a doctor listens to your chest with a stethoscope, he or she may hear a typical sound which occurs with pericarditis. It is called a pericardial friction rub. It sounds like a grating noise. This does not occur in all cases.
  • A chest X-ray may show a change in the shape of the heart or fluid in the lung cavity.
  • An electrocardiogram (ECG).
  • An echocardiogram is an ultrasound scan of the heart.
  • Other tests such as a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan may be needed to look for changes in the pericardium.
  • If a large pericardial effusion develops, a sample of the fluid may be taken with a needle and syringe and analysed for infections such as TB.
What is the treatment for pericarditis?

Treatment for viral or idiopathic pericarditis

Anti-inflammatory drugs such as ibuprofen are usually given to ease the pain and reduce inflammation. If the condition carries on for more than 14 days you may also be given a drug called colchicine, which helps to improve the outcome and reduce the chances of the inflammation coming back. If the pain is severe and you are not getting better with ibuprofen and colchicine, steroid medicines may be used to reduce the inflammation.

Treatment for other causes and for complications

The treatment depends on the cause. For example, antituberculosis medication for TB, antibiotics for bacterial infections, intensive dialysis for uraemic pericarditis, etc. If a lot of fluid builds up and causes cardiac tamponade, the fluid needs to be drained with a needle and syringe. If constrictive pericarditis develops and interferes with the heart's function, the thickened pericardium may need to be removed by an operation.

What is the outlook if you have pericarditis?

Most people with viral or idiopathic pericarditis recover fully within a few weeks without any complications. Pericarditis caused by heart attack or injury usually settles over one to two weeks. The outlook for other forms of pericarditis (uraemic, bacterial, TB, etc) can vary depending on the severity of the underlying cause.


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