Heart Inflammation Pericarditis

---

Pericarditis is inflammation of the pericardium — the sac surrounding the heart. This sac is made of two thin layers of tissue with a small amount of fluid between them. The fluid keeps the layers from rubbing against each other and causing friction. The pericardium holds the heart in its position in the chest and protects it from infection. Based on how long you have had pericarditis, your healthcare provider may label your pericarditis as acute , subacute (it occurs within weeks or a few months after the initial event that caused it), chronic , or recurrent.

Some people who have pericarditis also develop a pericardial effusion, which is a buildup of fluid in the sac around the heart. If too much fluid builds up, the heart may not be able to pump normally. This is a condition called cardiac tamponade , which can be life-threatening.

Sometimes, the cause of pericarditis is not known ( idiopathic ). It is not always necessary to know the cause of pericarditis for your healthcare provider to treat it. Causes of pericarditis include:

• Viral, bacterial, parasitic, or fungal infections
• Autoimmune disorders such as lupus or rheumatoid arthritis
• Surgery, injury, or trauma to the chest
• Uremia, a condition that occurs when the kidneys do not properly filter the urine and waste products build up in the blood
• Certain medicines or cancer treatments, such as blood thinners, heart medicines, and medicines called diuretics that help your body get rid of extra fluid
• Other medical conditions such as cancer or a heart attack

Symptoms of pericarditis can feel like a heart attack or other serious health problem. If you have chest pain or severe shortness of breath, or your symptoms get worse, call 9-1-1 or seek medical help right away. Pericarditis symptoms include:

• Chest pain that feels sharp, gets worse with breathing, and feels better with sitting up and leaning forward
• Irregular, fast heartbeat called pericardial friction rub
• Shortness of breath
• Pain in the neck or shoulders that can be mild or severe
• Fever

Your healthcare provider may perform these procedures and tests to help diagnose pericarditis.

• A physical exam to listen to your heart for a sound called “pericardial friction rub.” This sound is caused by the inflamed pieces of the pericardium rubbing against each other.
• An ECG (EKG)
• Heart imaging tests such echocardiography and chest x-ray
• Blood tests such as C-reactive protein (CRP). If you have pericarditis, your CPR level will be higher than normal because of the inflammation in the pericardium. Your healthcare provider can perform this test after you start taking medicine to see how well the medicine works at treating your pericarditis.

Once pericarditis is diagnosed, your healthcare provider may need to run more tests to find the cause and treat it.

Treatment can vary from person to person depending on the cause and how severe it is. The goal of most treatments is to lessen pain, lower inflammation of the pericardium, and fix pericardial effusion if neccesary 

Medicines

• Medicines to relieve pain and reduce inflammation include colchicine, aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Side effects are mainly gastrointestinal and include abdominal pain, nausea, vomiting, and diarrhea.
• Corticosteroids like prednisone lower the activity of the body’s immune system. With pericarditis, corticosteroids are used only in people who are not responding to or cannot take NSAIDs. Side effects can include weight gain and increased risk of infection.
• Intravenous immunoglobulin (IVIG) helps control the body’s immune and inflammatory response if you have an Autoimmune  disorder such as lupus.
• Antibiotics can treat a bacterial infection if that is the cause.

Procedures

• Pericardiocentesis is a procedure that removes extra fluid in the pericardium (pericardial effusion) with a thin needle. Risks of the procedure are rare but include bleeding, infection, or damage to the heart.
• Pericardiectomy is a surgery to remove part or most of the pericardium. This treatment is only recommended when medicine or other treatments have not worked. It can be a successful option for people who have pericarditis that goes away and comes back or who have end-stage constrictive pericarditis, which develops when the pericardium becomes thickened and scarred.