Pericarditis is a condition in which the sac-like tissue that surrounds the heart (the pericardium) becomes inflamed, swollen or irritated. The amount of fluid that surrounds the heart within the pericardial sac can increase and cause a condition called a pericardial effusion. An electrocardiogram (EKG) may show signs of this. An echocardiogram is the definitive test to assess for the build-up of fluid around the heart. A characteristic sound called a pericardial rub may be heard with a stethoscope, though it is not present if the collection of fluid is large. Other tests that can help diagnose pericarditis include computerized tomography (CT) or magnetic resonance imaging (MRI).

There are many causes of pericarditis. In many cases, doctors cannot determine the exact cause. Viral infections, bacterial infections, autoimmune diseases, kidney failure, medications that suppress the immune system and injury to the chest can result in pericarditis.

Symptoms of Pericarditis

The most common symptom of pericarditisis sharp, stabbing chest pain. It is caused by friction from the inflamed sac around the heart. The chest pain is usually relieved by sitting up or leaning forward. The pain can sometimes feel worse with coughing or taking a deep breath. Pericarditis can also cause shortness of breath while lying down, low-grade fever, dry cough, abdominal or leg swelling and an overall sense of weakness or fatigue.

Progression and Possible Complications of Pericarditis

Pericarditis can range from mild cases that get better on their own to life-threatening cases. It usually lasts less than several weeks, but occasionallu cases can last 6 months or longer. The outcome is generally good if pericarditis is treated promptly. The condition may be complicated by significant fluid build-up around the heart (pericardial effusion). Excess fluid can put pressure on the outside of the heart and prevent it from filling properly. This means less blood can be pumped out of the heart, causing a drop in blood pressure.

Some people with pericarditis who have long-term inflammation or several recurrences can develop permanent thickening or scarring of the pericardium. If this occurs, the pericardium can become stiff and act like a rigid box around the heart, preventing the heart from filling and working properly. This can lead to shortness of breath and swelling of the legs and abdomen. When this occurs, it is called constrictive pericarditis.

Treatment for Pericarditis

Mild cases of pericarditis may not require treatment. However, if the pericarditis is more severe, treatment is directed at the initial cause for pericardial inflammation. 

Infectious diseases are treated with appropriate medications. Anti-inflammatory medications, such as ibuprofen or steroids, are commonly used as well. 

If a large fluid collection (effusion) has developed, drainage of the effusion may be necessary. A drainage tube (catheter) is temporarily placed into the sac that surrounds the heart. After the amount of fluid build-up slows down, the catheter is removed. Occasionally, fluid build-up may reoccur. If this happens, a surgical procedure may be necessary to allow fluid to drain away from the heart. The surgeon cuts away a small piece of the sac (called a pericardial window). 

If a patient has constrictive pericarditis, treatment may consist of surgery to remove the pericardium, called a pericardiectomy.