The pericardium is a thin fibrous membrane sac that surrounds the heart. The pericardium consists of:
- An inner layer (visceral pericardium) – envelopes the entire heart
- An outer layer (parietal pericardium) – the outer fibrous sac
- A middle fluid layer – a small amount of fluid lies between the two layers to prevent friction between the two surfaces.
Pericarditis is inflammation of any of the layers of the pericardium.
Pericarditis can be caused by:
- After heart surgery
- Infections
- After a heart attack
- Trauma
- Tumors
- Cancer
- Radiation
- Auto-immune diseases (such as rheumatoid arthritis, lupus, or scleroderma)
- No cause may be found
It can be acute (occurring suddenly) or chronic (occur over time).
Symptoms of Pericarditis may include any of the following:
- Chest pain: this pain is different from angina (pain caused by coronary artery disease). It may be sharp and located in the center of the chest. The pain may radiate to the neck and occasionally, arms and back. It is made worse when lying down, coughing or swallowing and relieved by sitting forward.
- Low-grade fever
- Increase in heart-rate
- No symptoms may be present
Diagnosis is based on:
- Symptoms
- EKG (electrocardiogram) changes
- Physical exam – the doctor will hear a sound, with his stethoscope, as the inflamed layers of the heart rub together
- Other tests may be done to determine the cause of the pericarditis
Treatment is based on the cause and may include:
- Non-steroidal anti-inflammatory agents (NSAIDS) are used to decrease the pain and inflammation.
- Occasionally steroids are used for severe attacks.
- Antibiotics if the pericarditis is due to infection.
Most patients recover in two to four weeks.
Constrictive Pericarditis
In severe pericarditis, the layers of the pericardium may become stiff and stick together. This prevents the heart muscle from expanding during filling and impacts on the function of the heart.
The symptoms include the same as pericarditis with the addition of:
Diagnostic testing may also include the echocardiogram, cardiac catheterization, MRI, or CT scan.
Treatment of constrictive pericarditis include:
- Analgesics and anti-inflammatory agents to treat pain or inflammation
- Diuretics to treat heart failure symptoms
- Anti-arrhythmics if necessary, to treat any heart arrhythmias, such as atrial fibrillation
- Pericardiectomy – in some cases, the stiff pericardium may need to be removed from the heart during heart surgery.
Resources:
Klein, AL, Scalia GM (1998) Diseases of the Pericardium, Restrictive Cardiomyopathy and Diastolic Dysfunction. In (E. Topol ed.) Textbook of Cardiovascular Medicine, Lippincott-Raven: Philadelphia, pp.639-705.
Conditions A-Z, Pericarditis, http://onhealth.com/conditions*
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