Heart Disease and Pericarditis

Pericardial disease, or pericarditis, is inflammation of any of the layers of the pericardium. The pericardium is a thin tissue sac that surrounds the heart and consists of:

• Visceral pericardium -- an inner layer that envelopes the entire heart
• A middle fluid layer to prevent friction between the visceral pericardium and parietal pericardium
• Parietal pericardium -- an outer layer made of fibrous tissue

What Causes Pericarditis?

Causes of pericarditis include:

• Infections
• Heart surgery
• Heart attack
• Trauma
• Tumors
• Cancer
• Radiation
• Autoimmune diseases (such as rheumatoid arthritis, lupus, or scleroderma)

For some people, no cause can be found.

Pericarditis can be acute (occurring suddenly) or chronic (long-standing).

What Are the Symptoms of Pericarditis?

When present, symptoms of pericarditis may include:

• Chest pain. This pain is frequently sharp and located in the center of the chest. The pain may radiate to the neck and shoulders, and occasionally, the arms and back. It can be made worse when lying down, coughing, or swallowing and may be relieved by sitting forward.
• Low-grade fever.
• Increased heart rate.

How Is Pericarditis Diagnosed?

Your doctor can diagnose pericarditis based on:

• Reported symptoms
• Electrocardiogram (EKG or ECG) results
• Echocardiogram
• Cardiac MRI
• Physical exam

Other tests may be performed to determine the cause of pericarditis.

What Is the Treatment for Pericarditis?

Treatment of pericarditis is based on the cause and may include:

• Nonsteroidal anti-inflammatory agents (NSAIDs) to decrease the pain and inflammation
• Steroids, used occasionally for severe attacks
• Antibiotics, if the pericarditis is due to infection
• Colchicine, particularly if symptoms last for several weeks or occur on a repetitive basis

Most patients recover from pericarditis in two to four weeks.

What Is Constrictive Pericarditis?

Constrictive pericarditis occurs when the pericardium becomes thickened and scarred. This can make it difficult for the heart to expand with blood.

What Are the Symptoms of Constrictive Pericarditis?

The symptoms of constrictive pericarditis are the same as pericarditis, with the addition of:

• Shortness of breath
• Fatigue (feeling over-tired)
• Heart failure symptoms (swelling of legs and feet, unexplained weight gain)
• Atrial fibrillation (irregular heartbeat)

How Is Constrictive Pericarditis Diagnosed?

The same tests used to diagnose pericarditis are used to diagnose constrictive pericarditis. Other diagnostic tests used for constrictive pericarditis include:

• Echocardiogram
• Cardiac catheterization
MRI
• CT scan

How Is Constrictive Pericarditis Treated?

Treatment of constrictive pericarditis may include:

• Analgesics and anti-inflammatory agents to treat pain or inflammation
• Diuretics to treat heart failure symptoms
• Antiarrhythmics to treat any abnormal heart rhythms, such as atrial fibrillation
• Pericardiectomy (the surgical removal of the stiff pericardium from the heart)

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