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Pericarditis

Definition

Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

See also: Bacterial pericarditis

Causes, incidence, and risk factors

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection.

Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal infections can also produce pericarditis.

In addition, pericarditis can be associated with diseases such as:

Other causes include:

  • Heart attack (see post-MI pericarditis)
  • Injury (including surgery) or trauma to the chest, esophagus, or heart
  • Medications that suppress the immune system
  • Myocarditis
  • Radiation therapy to the chest

Often the cause of pericarditis remains unknown. In this case, the condition is called idiopathic pericarditis.

Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections. In children, it is most commonly caused by adenovirus or coxsackie virus.

Symptoms

Signs and tests

When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be:

If fluid has built up in the pericardial sac, it may show on:

These tests show:

Other findings vary depending on the cause of pericarditis.

To rule out heart attack, the health care provider may order serial cardiac marker levels (CPK-MB and troponin I). Other laboratory tests may include:

Treatment

The cause of pericarditis must be identified, if possible.

Medications include:

  • Analgesics for pain
  • Antibiotics for bacterial pericarditis
  • Antifungal medications for fungal pericarditis
  • Aspirin or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen for inflammation of the pericardium
  • Corticosteroids such as prednisone (in some patients)
  • Colchicine

If the buildup of fluid in the pericardium makes the heart function poorly or produces cardiac tamponade, it is necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or minor surgery.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.

Expectations (prognosis)

Pericarditis can range from mild cases that get better on their own to life-threatening cases. The condition can be complicated by significant fluid buildup around the heart and poor heart function.

The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months. However, pericarditis may come back.

Complications

Calling your health care provider

Call your health care provider if you experience the symptoms of pericarditis. This disorder can be life threatening if untreated.

Prevention

Many cases are not preventable.

References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.


Review Date: 5/4/2010
Reviewed By: Issam Mikati, MD, Associate Professor of Medicine. Feinberg School of Medicine, Northwestern University, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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