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Pericarditis is when the pericardium has inflammation. The pericardium is the two thin layers of sac-like tissue that surround the heart. It holds the heart in place and helps it work. A small amount of fluid keeps the layers separate so that there’s no friction between them.

Pericarditis can happen suddenly (acute) and doesn’t last long. Or it can be chronic, meaning it develops over time. Chronic pericarditis may take longer to treat. Both types of pericarditis can disrupt your heart’s normal rhythm or function. In rare cases, pericarditis can lead to death.

What happens once you have pericarditis?

A common symptom of pericarditis is chest pain, caused by the sac’s layers becoming inflamed and possibly rubbing against the heart. It may feel like pain from a heart attack. The pain usually occurs behind the breastbone or on the left side of your chest. It may spread to your left shoulder and neck. It can get worse when you cough, lie down or take a deep breath. Sitting up and leaning forward can help you feel better.

Other signs and symptoms of pericarditis may include:

  • Cough.
  • Low-grade fever.
  • Abdominal or leg swelling.
  • Shortness of breath when lying down.
  • Pounding or racing heartbeat (heart palpitations).
  • Fatigue or a general feeling of weakness or being sick.

The specific symptoms you have depend on the type of pericarditis you have. Acute pericarditis begins suddenly but doesn't last longer than three weeks. It can re-occur in the future. Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with no symptoms in between.

What causes pericarditis?

Pericarditis can have different causes: viral, bacterial, fungal, and other infections. Chronic or recurring pericarditis can be caused by autoimmune disorders such as lupus, scleroderma, and rheumatoid arthritis. (With autoimmune disorders, the body’s immune system makes antibodies that mistakenly attack the body’s tissues or cells.)

Other possible causes of pericarditis are:

  • Heart attack and heart surgery.
  • Injuries from accidents or radiation therapy.
  • Kidney failure, HIV/AIDS, cancer, tuberculosis, and other health problems.
  • Certain medicines, like phenytoin (an anti-seizure medicine), warfarin and heparin (both blood-thinning medicines), and procainamide (a medicine to treat irregular heartbeats).

Pericarditis affects people of all ages, but men 20 to 50 years old are more likely to develop it.

What types of tests are used to diagnosis pericarditis?

Your doctor will examine you and ask questions about your symptoms and medical history. The doctor will listen to your heart with a stethoscope. Pericarditis causes a specific sound called a "pericardial rub." The noise happens when the two layers of the pericardium rub against each other.

Blood tests are usually done to check for signs of a heart attack, inflammation, and infection. Other tests used to diagnose pericarditis include:

  • Electrocardiogram (EKG): An electrocardiogram is a quick and painless test that records the electrical signals in your heart.

  • Chest X-ray: A chest X-ray can show changes in the size and shape of your heart. The images may show an enlarged heart if the excess fluid has collected in the pericardium.

  • Echocardiogram: Sound waves (ultrasound) create images of the moving heart. Your doctor can use this test to see how well your heart is pumping blood and fluid buildup in the pericardium.

  • Cardiac computerized tomography (CT) scan: Cardiac CT scans use X-rays to create images of your heart and chest. The test can be used to look for thickening that may be a sign of constrictive pericarditis.

  • Cardiac magnetic resonance imaging (MRI): Cardiac MRI uses a magnetic field and radio waves to create cross-sectional images of your heart that can reveal thickening, inflammation, or other changes in the pericardium.

What types of treatments and procedures are used to treat pericarditis?

Most of the time, pericarditis is mild and clears up on its own. Sometimes, more intense treatment is needed.

Medications to reduce inflammation and swelling include:

  • Over-the-counter pain relievers, such as aspirin or ibuprofen.
  • Anti-inflammation drugs treat acute pericarditis or recurring symptoms of the disease.
  • Corticosteroids fight inflammation if your symptoms don't get better with other medications or if symptoms keep returning.
  • Antibiotics are used if a bacterial infection is the cause of your pericarditis.

If pericarditis causes fluid buildup around the heart, you may need drainage or surgery. Treatments include:

  • Pericardiocentesis: A doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a numbing medication (local anesthetic) before the procedure. The doctor uses ultrasound and echocardiogram images to guide the needle and tube to the body's correct location. This drain stays in place for several days while you are in the hospital.

  • Pericardiectomy: This surgery removes the pericardium. It may be done if the sac surrounding your heart has become permanently rigid.

What can I do to support my health when I have pericarditis?

For mild pericarditis, rest and over-the-counter pain medications may be all that's needed. While you recover, avoid strenuous physical activity and competitive sports. Such activity can bring back pericarditis symptoms.

If you have been prescribed medications, take them as instructed and follow up with your doctor.

Why choose Presbyterian for pericarditis treatment?

Presbyterian Heart and Vascular Care has a team of highly-skilled surgeons who are using some of the most trusted and advanced surgical techniques. Their surgical team can help you decide what treatment is best for you and help you prepare for your procedure.