Pericarditis Causes, Diagnosis, and Treatment

Pericarditis is a condition in which the pericardium (the protective elastic sac that encloses the heart), becomes inflamed. Often, this inflammation is relatively mild and transient. But in some cases, pericarditis can lead to severe illness and even to cardiac damage.

Causes

Pericarditis can be caused by a number of conditions, including infection, heart attack, autoimmune disorders, chest trauma, cancer, kidney failure, or drugs.

Infections that can produce pericarditis include viral infections, bacterial infections, tuberculosis, and fungal infections. People with human immunodeficiency virus (HIV)/AIDS frequently develop infections that produce pericarditis.

Autoimmune disorders that can cause pericarditis include rheumatoid arthritis, lupus, and scleroderma.

Pericarditis can occur within one to three days after an acute heart attack. There is also a late form of post–heart attack pericarditis, called Dressler's syndrome, that occurs weeks to months after the heart attack.

Some drugs that can produce pericarditis include Pronestyl (procainamide), Apresoline (hydralazine), Dilantin (phenytoin), and Hydra (isoniazid).

Many forms of cancer can metastasize (spread) to the pericardium and produce pericarditis.

In many cases, no definite cause for pericarditis can be identified—this is called idiopathic (meaning of unknown cause) pericarditis.

Symptoms

The most common symptom caused by pericarditis is chest pain. The pain can be severe and is often made worse by leaning forward, changing position, or taking a deep breath. 

People with pericarditis may also develop dyspnea (shortness of breath) and fever.

Diagnosis

Doctors can usually diagnose pericarditis by taking a careful medical history, performing a physical examination, and doing an electrocardiogram (ECG, which shows characteristic changes). Sometimes an echocardiogram can be helpful in making the diagnosis.

Complications

While pericarditis usually resolves within a few days or a few weeks, three complications can occur. These are cardiac tamponade (compression of the heart caused by extra fluid in the pericardium), chronic pericarditis (long-term inflammation of the pericardium), or constrictive pericarditis (thickening and scarring of the pericardium).

Tamponade occurs when fluid accumulating in the pericardial sac (a condition called pericardial effusion) prevents the heart from filling completely. When this happens, your blood pressure drops and your lungs become congested, often leading to weakness, dizziness, light-headedness, and extreme dyspnea. The diagnosis of tamponade is made with an echocardiogram.

Chronic pericarditis is said to be present when the pericardial inflammation does not resolve within a few weeks. It can be associated with all the symptoms of acute pericarditis and, in addition, is often accompanied by particularly large pericardial effusions.

Constrictive pericarditis occurs when a chronically inflamed pericardial sac stiffens and loses its elasticity, which (similar to tamponade) prevents the heart from filling completely. The symptoms are the same as with tamponade but usually have a much more gradual onset.

Treatments

The management of acute pericarditis is aimed at identifying and treating the underlying cause. The symptoms can usually be improved with anti-inflammatory drugs (usually nonsteroidal anti-inflammatory drugs, or NSAIDs, but sometimes steroid therapy is necessary), and analgesics. Most cases of acute pericarditis resolve within a few weeks and leave no permanent cardiac problems.

Cardiac tamponade is treated by draining the fluid from the pericardial sac, usually through a tiny catheter. Removing the fluid relieves the pressure on the heart and restores normal cardiac function almost immediately.

Chronic pericarditis is remedied by aggressively treating the underlying inflammatory condition and draining the large pericardial effusion that is often present.

If pericardial effusions continue to recur, surgery can be done to create a permanent opening (a so-called pericardial window), that allows the fluid to drain from the pericardial sac, thus preventing tamponade.

Constrictive pericarditis can be a very difficult therapeutic problem. Symptoms can be treated with bed rest, diuretics, and digitalis, but definitive treatment requires surgery to strip the stiffened pericardial lining away from the heart. This surgery is often quite extensive and carries significant risks.

A Word From Verywell

Pericarditis is often a self-limited condition that resolves when the underlying medical problem is treated. In some cases, however, pericarditis can become chronic and can lead to more serious problems. As is the case with any cardiac problem, it is important for anyone with pericarditis to receive good medical care.