Pericardial Disease

The most common pericardial disease, pericarditis, causes inflammation and chest pain. Many things can trigger it, including a virus, post-cardiac injury syndromes, autoimmune conditions or cancer. And sometimes there’s no known cause (idiopathic).

You might have pericarditis for a short time and never have it again (acute pericarditis). Other times, it might show up for a bit, go away for four to six weeks and then come back (recurrent pericarditis). It might continue unrelenting (incessant), or it may last for several months or more after the first attack (chronic pericarditis).

Other types include:

• Constrictive pericarditis: Repeated bouts of inflamed tissue cause stiff scarring and symptoms of heart failure.
• Post-cardiac injury. An uncommon type that can start after a heart attack, surgery, procedures or injury.
• Infectious pericarditis: Viral, bacteria or fungal infections can trigger this.
• Idiopathic pericarditis: There’s no known cause for inflammation.
• Traumatic pericarditis: Chest injuries can trigger it.
• Uremic pericarditis: Kidney failure causes inflammation.
• Neoplastic pericarditis: Cancer may cause fluid around the heart.

Your pericardium can also get pericardial cysts, pockets of pus (abscesses) and tumors, like angiosarcoma or mesothelioma. Other cancers, like lymphoma, can cause malignant pericarditis. All these things can also cause pain and inflammation.

Another pericardial disease, pericardial effusion, can cause extra fluid to build up in your pericardium. Sometimes, this condition can lead to another pericardial disease, cardiac tamponade (pressure that keeps your heart from beating). This has to be treated right away with immediate drainage with a needle (pericardiocentesis) or surgery (pericardial window).

What to expect at your first visit

We want you to feel as comfortable as possible when you come to your first appointment. That’s why your provider will take time to get to know you. And they’ll ask you to share your story. They’ll want to know:

• Are you having symptoms?
• When did your symptoms start?
• Are your symptoms getting worse?
• Have you had any tests before coming to this appointment?
• Do you have other health conditions?
• Does anyone in your family have heart conditions?

While you’re here, your provider will do a physical exam and they’ll listen to your heart. An inflamed pericardial lining can make a creaking sound called “pericardial rub.” It can also cause crackling-like sounds in your lungs from the extra fluid. They’ll also check the jugular veins in your neck to see if they’re distended and if your ankles and belly are swollen.

Testing

You may need one or more tests to check for pericardial disease, signs of inflammation and other complications. You may have:

• Cardiac blood tests.
• Chest X-ray.
• Electrocardiogram (EKG).
• Echocardiogram (Echo).
• Cardiac MRI (magnetic resonance imaging).
• CT scan (computed tomography).
• Cardiac catheterization (cardiac cath).

Meet Our Pericardial Disease Team

Pericardial disease has many causes. So while you’ll have cardiologists leading your Cleveland Clinic care team, you’ll also have other providers from different specialties caring for you, like:

• Cardiothoracic surgeons.
• Rheumatologists.
• Radiologists.
• Pathologists.
• Radiologic technologists.
• Nurse practitioners.

The providers on your care team work together to pinpoint a diagnosis and build a personalized treatment plan.

Your treatment plan depends on what’s causing your pericardial disease and how much it’s impacting your life. Your care team will go over treatment options, like:

Medications

If you have acute pericarditis, you may only need to take medications for inflammation and pain. These might include ibuprofen (Motrin® or Advil^®), Naproxen (Aleve^®) or a high dose of aspirin. Your provider will also prescribe colchicine (Colrys^® or Gloperba^®) to reduce inflammation and prevent pericarditis from coming back (recurrence).

If a bacterial or fungal infection caused your condition, you may need to take antibiotics or antifungal medication. You may also take water pills (diuretics) to help reduce fluid buildup.

Targeted therapy

Targeted or precision therapy is a newer way to treat pericardial disease. Two of the medications used in targeted therapy are anakinra and rilonacept.

Treatments to relieve fluid and pressure

If you have fluid buildup in your pericardium, we may need to remove it with a treatment called pericardiocentesis. We use imaging to guide a thin tube (catheter) to your pericardium. If we can’t drain all the fluid, you may need a treatment called a pericardial window. We make a small incision (cut) in your chest to drain fluid from your pericardium.

We don’t typically do surgery to treat pericardial disease that keeps coming back. But your provider may recommend it if other treatments don’t work. You may also need surgery if you have constrictive pericarditis (scar tissue on your pericardium). We treat this condition with a radical pericardectomy. It removes the damaged part of your pericardium to relieve pressure and help your heart work better.

Traveling for Heart Care at Cleveland Clinic

We know that traveling for any kind of healthcare can often be stressful. And troubles with your heart can make travel especially worrisome. At Cleveland Clinic, we want to take as much of the stress out of traveling for care as possible. If you’re coming to us from another city, state or even another country, we’re here to help make things as easy and convenient as possible for you. From knowing where to stay and eat to how to get to and from the airport, shop or just find your way around Cleveland Clinic, we’re here for you.

If you’re an international patient, our experienced and compassionate Global Patient Services (GPS) team will help you navigate Cleveland Clinic. They’ll connect you with the healthcare providers you need, help you make appointments, provide language translation services and coordinate follow-up care when you return home.

Follow-Up Care for Pericardial Disease

Your providers will recommend limited exercise as you recover from pericardial disease. After you recover, you should be able to return to your regular activities. Your provider will let you know when it’s ok to do that.

It’s important to understand that pericarditis often comes back (recurs). Follow-up appointments help us keep an eye on your progress and look for signs of recurring or chronic (ongoing) pericardial disease.

Taking the Next Step

It’s natural to worry when you hear you may have inflammation around your heart. The good news? Pericardial disease is treatable. Our experts are here to answer your questions, listen to your concerns and explain your personalized treatment plan throughout recovery and beyond. We’re ready to help you take the next step toward a healthy heart.