Pericarditis

About pericarditis

The heart is surrounded by a protective sac called the pericardium. The pericardium is made up of two layers of thin tissue (membrane) that contain fluid. The fluid allows the layers to glide smoothly over each other when the heart beats. The pericardium helps keep the heart in place and protects it.

When the pericardium becomes inflamed, this is called pericarditis. The inflammation causes the membrane layers to swell and rub against each other as the heart contracts and relaxes.

The symptoms of pericarditis can be similar to those of a heart attack and can include chest pain, shortness of breath and palpitations. It is always important to seek medical help as soon as possible if you experience these symptoms.

Pericarditis is usually mild and can be managed with rest and medicines, if needed.

Symptoms of pericarditis

Depending on the type of pericarditis you have, symptoms can vary and can include:

• sharp and stabbing chest pains
• pain radiating into the left shoulder and arm
• pain that gets worse if you’re lying down or taking deep breaths
• a fever
• sweating and chills
• feeling short of breath or trouble breathing
• dizziness
• feeling faint
• dry cough
• palpitations or a racing heart, which can be a sign of an abnormal heart rhythm.

Symptoms of acute pericarditis can last from one to three weeks. Chronic pericarditis lasts three months or longer.

Causes of pericarditis

The cause of your pericarditis may not always be clear. Causes of pericarditis include:

• viral infection
• bacterial infection
• heart attack
• chest injury
• heart surgery
• kidney failure
• autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus
• cancer
• radiation therapy.

Viral pericarditis

A viral infection is the most common cause of pericarditis. For example, a chest infection caused by a virus can lead to pericarditis.

You may be prescribed medicines to help reduce the inflammation and to relieve pain.

Bacterial pericarditis

Pericarditis caused by a bacterial infection is potentially fatal, so it is very important to seek medical treatment as soon as possible.

Most cases of bacterial pericarditis are caused by infections somewhere else in the body. For example, if you have bacterial pneumonia (a lung infection), you may develop pericarditis if the bacteria in your system infects the pericardium directly or through your bloodstream.

Seeking medical help as soon as possible to treat infections (such as pneumonia) for example, will help reduce the chance of developing bacterial pericarditis.

Constrictive pericarditis

As the pericardium recovers from injury or inflammation, scar tissue may form. Scar tissue makes the pericardium less flexible, so the heart can’t beat properly and pump blood around the body as it should.

Symptoms of constrictive pericarditis can include:

• fatigue
• feeling short of breath or trouble breathing
• dizziness
• feeling faint
• swelling of the abdomen or lower legs (due to fluid build up)
• heart palpitations (due to an abnormal heart rhythm)

Without treatment, constrictive pericarditis can lead to complications including:

• abnormal heart rhythm (heart arrhythmia)
• heart failure
• liver damage.

Post-heart attack pericarditis

The injury to heart tissue caused by a heart attack can sometimes lead to pericarditis. This is known as post-heart attack (or post-myocardial infarction) pericarditis.

The symptoms of pericarditis may not appear for some weeks or months after the heart attack.

Pericarditis after heart surgery

Pericarditis may rarely occur after heart surgery. Certain heart surgeries involve opening the pericardium, including coronary artery bypass graft surgery and heart valve surgery. Pericardial thickening or scarring can happen after heart surgery and this can contribute to pericarditis after surgery.

Chronic effusive pericarditis

Long-term inflammation causes a gradual build-up of fluid within the two layers of the pericardium. In most cases, the reasons for this are unknown. Two of the known causes of chronic effusive pericarditis are tuberculosis and hypothyroidism (underactive thyroid gland).

Diagnosis of pericarditis

To diagnose pericarditis, your doctor will ask about your medical history and do a physical examination. Your doctor will listen to your heart with a stethoscope.

A stethoscope is typically placed on the chest and back to listen to heart sounds. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding the heart (pericardium) rub against each other if the pericardium is inflamed.

Your doctor may also organise some tests including:

• blood tests
• an electrocardiogram (ECG)
• a chest X-ray
• an echocardiogram (ultrasound of the heart)
• a heart computerised tomography (CT) scan
• magnetic resonance imaging (MRI) scan of the chest
• taking a sample of pericardium fluid (using a fine needle) that will be examined in a laboratory.

Treatment for pericarditis

Treatment for pericarditis depends on the cause and severity, but may include:

• limiting physical activity if necessary. This can help limit the strain on your heart and prevent or limit damage to your heart muscle
• medicines for pain relief
• medicines to reduce inflammation, such as colchicine or, in some cases, non-steroidal anti-inflammatory medicines (NSAIDS) or corticosteroids – if your doctor decides they are necessary
• antibiotics – if your pericarditis is caused by a bacterial infection.

Surgeries and other procedures

If pericarditis causes fluid build-up around the heart, a surgery or other procedure may be needed to drain the fluid.

Surgeries or other procedures to treat pericarditis include:

• Pericardiocentesis. In this procedure, a sterile needle or a small tube (catheter) is used to remove and drain the excess fluid from around the heart.
• Removal of the pericardium (pericardiectomy). The entire pericardium may need to be removed if the sac surrounding the heart is permanently stiff due to constrictive pericarditis. This surgery is only rarely required.

Complications of pericarditis

Some of the complications of pericarditis include:

• cardiac tamponade – this can happen when more fluid than usual builds up between the two layers of the pericardium. The heart is compressed and can’t pump properly. This requires urgent medical attention and left untreated can be fatal.
• abscess – this is a build-up of pus either within the heart or in the pericardium
• spread of infection – as with any infection, the infection in the pericardium can spread to other parts of the body and infect the blood.

Where to get help

• Your GP (doctor)
• In an emergency, always call triple zero (000)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours a day, 7 days a week)