Pericarditis

DEFINITION

Pericarditis is swelling and irritation of the pericardium, the thin sac-like membrane surrounding your heart. Pericarditis often causes chest pain and sometimes other symptoms. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other.

Pericarditis usually begins suddenly but doesn’t last long (acute). When symptoms develop more gradually or persist, pericarditis is considered chronic.

Most cases are mild and usually improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications from pericarditis.

CAUSES

Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting friction from the inflamed sac leads to chest pain.

The cause of pericarditis is often hard to determine. In most cases, doctors either are unable to determine a cause (idiopathic) or suspect a viral infection.

Pericarditis can also develop shortly after a major heart attack, due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery. This delayed pericarditis is known as Dressler’s syndrome. Many experts believe Dressler’s syndrome is due to a mistaken inflammatory response by the body to its own tissues (autoimmune response) — in this case, the heart and pericardium.

Other causes of pericarditis include:

• Systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.
• Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
• Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.
• Certain medications. Some medications can cause pericarditis, although this is unusual.

SYMPTOMS

Acute pericarditis usually lasts less than a few weeks. Chronic recurrent pericarditis has two types, including the incessant type which occurs within six weeks of weaning medical treatment for an acute episode, and the intermittent type which occurs after six weeks.

If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.

The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you cough, lie down or inhale deeply. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.

Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.

Depending on the type, signs and symptoms of pericarditis may include some or all of the following:

• Sharp, piercing chest pain over the center or left side of the chest
• Shortness of breath when reclining
• Heart palpitations
• Low-grade fever
• An overall sense of weakness, fatigue or feeling sick
• Cough
• Abdominal or leg swelling

When to see a doctor

Seek immediate medical care if you develop new symptoms of chest pain.

Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could have been a heart attack or a blood clot of the lungs (pulmonary embolus).