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Everyone both women and men can be considered in the risk group of developing pericarditis, however younger men seem to be the more prominent risk factor.

Someone would fall in to the category of a high risk factor for this, if they have suffered from a previous heart attack. As well as other long lasting health conditions such as; kidney failure, cancer or TB.

Other risk factors included are; people who have immunity disorders, have hyperthyroidism or under active thyroid glands, history of radiation therapy, continuous dry coughs, Aids or HIV.

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Pericarditis is the swelling or inflammation that occurs in the pericardium. Pericardium is the lining membrane that is found surrounding the human heart. This inflammation causes mild to severe chest pain and pericardial effusion (fluid accumulation in the heart). The pericardial effusion is the process by which the extension of pericardium occurs to accommodate the excess fluid.

People at Risk

Pericarditis is a common heart condition that is found all over the world. It has been reported that almost 5% of overall admissions that occur due to accidents and emergency (A&E) are identified with pericarditis.

As it is a common condition, both men and women are victims. But compared to women, men are more likely to get affected with pericarditis. Young men in the adult category are more likely to be affected than older people and, in general, men between 20 and 40 years of age are more visible victims of the condition.

Additionally, about 20-30% of people who undergo treatment for pericarditis have the chance of developing the condition again, among which a minimum number have a tendency to land up in a chronic pericarditis stage.

Who Gets Affected?

As pericarditis is a common condition, it does not necessarily have specific causes. Infection plays a vital role in causing pericarditis. People who are prone to some viral, bacterial, or fungal infection have a huge chance of having pericarditis. Other people who develop this condition might have experienced the following situations:

Heart attack:People who had heart attacks have a high chance of developing pericarditis. This kind of pericarditis falls under two categories-early pericarditis and late pericarditis.

Early pericarditis is the condition that occurs in just one to four days after a person suffers a heart attack. In this case, the swelling or inflammation is considered to develop to clean up the disease tissue that arose in the heart. In contrast, late pericarditis is known to develop after a few weeks or months after a heart attack. It occurs when the heart tissue is unintentionally attacked by the immune system.

Late pericarditis is known by several names such as the Dressler syndrome or postcardiotomy pericarditis or the post-cardiac injury syndrome.

Heart surgery: It has not been proved that all people who have a heart surgery develop pericarditis, but there are reports that some people who had surgeries developed this condition at a later stage in their lives.

Kidney failure: People who have end-stage renal disease (ESRD) are prone to develop pericarditis. There are chances for them to develop even chronic constrictive pericarditis. The two forms of pericarditis that occur as a result of renal failure are as follows:

1. Uremic pericarditis is the result of swelling of the visceral membrane that occurs in the pericardial sac. The systemic immune disorders such as scleroderma and lupus erythematosus are considered to be the cause of this pericarditis.

2. Pericarditis that is related to dialysis: This category of pericarditis is eventually observed in patients during dialysis (peritoneal dialysis and hemodialysis). Inadequate dialysis and excess of fluids are determined as the factors that contribute to the cause of this pericarditis.

Cancer: The extension of cancer cells to the neighboring structures can affect the pericardium and cause pericarditis. The cancer cells can also be carried through the bloodstream by the hematogenous method. The other cancers that cause pericarditis are breast cancer, lung cancer, leukemia, non-Hodgkin lymphoma and Hodgkin's lymphoma.

Tuberculosis:Pericardial tuberculosis occurs as a complication of tuberculosis. It is difficult to diagnose this pericarditis and is often left unnoticed during the diagnosis of TB, but this has the capability to result in constrictive pericarditis.

Common Risk Factors

People under the following categories are said to be under the risk of pericarditis.

A person who has rapid and heavy breathing.

A person who suffers from breathlessness.

A person who frequently suffers from dry cough.

A person who has abnormality in his/her body temperature or falls sick often.

A person whose blood vessels are broken in the mucous membrane lining the lungs and the eyes.

A person who has immunity disorders.

A person found with AIDS or HIV.

A person who has undergone radiation therapy on the chest.

A person who has rheumatic fever or has had rheumatic fever in the past.

A person who has hypothyroidism or under-active thyroid glands.

In common cases, pericarditis is more likely to be mild and vanishes within days. When it occurs frequently and is left untreated, it can lead to chronic pericarditis or other serious problems that can affect the functioning of the heart. Usually, it takes about a week to recover from pericarditis; however, for complete recovery, patients are advised to take complete rest and continue follow-up treatment. These methods help patients reduce the risk of acquiring the condition again.

Further Reading

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Pericarditis is the swelling or inflammation that occurs in the pericardium. Pericardium is the lining membrane that is found surrounding the human heart. This inflammation causes mild to severe chest pain and pericardial effusion (fluid accumulation in the heart). The pericardial effusion is the process by which the extension of pericardium occurs to accommodate the excess fluid.

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commonly caused by infection - viral, bacterial or fungal. viral make up 85% of cases and the viruses commonly include coxsackievirus, herpesvirus, mumps virus, and HIV. Bacterial is the next most common cause, TB and pneumococcus. fungal is the least common cause and is commonly only seen in immunocompromised hosts.As well as a bacterial infection pericarditis can be idiopathic, from an autoimmune disease, side affect from an MI, caused from trauma, high levels of ureaia in blood -uremia, cancer, side effect from medication, radiation induced, aortic dissection or postercardiotomy syndrome e.g. a patient recovering from a CABG

Aetiology? What changes in the body?
When pericarditis occurs this is due to the lining of the pericardial sac becoming inflamed, causing fluid to build up within and around the sac.

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Pericarditis definition and facts

Picture of the heart in the pericardial sac

Pericarditis is an inflammation of the lining surrounding the heart (the pericardial sac).

Pericardial effusion is a collection of fluid in the pericardial sac. This fluid may be produced by inflammation.

The cause of pericarditis in most individuals is unknown but is likely due to viral infection. Pericarditis may be an associated complication of many diseases or may be due to trauma.

The diagnosis of pericarditis is made by history and physical examination. Testing usually includes an electrocardiogram (EKG, ECG), chest X-ray, and echocardiogram, or ultrasound of the heart. The inflammation of pericarditis is usually treated with anti-inflammatory medications (such as ibuprofen). It is important to treat the underlying disease or illness if one is present.

Pericardial tamponade occurs when enough fluid accumulates in the sac to compromise the heart's ability to adequately pump blood.

Tamponade is a medical emergency and is treated by pericardiocentesis, inserting a needle into the pericardial sac to remove the fluid.

What is pericarditis?

The heart muscle has a tight covering that surrounds it, a lining sac called the pericardium (peri=around+cardium=heart). This sac actually has two layers. The visceral pericardium is only one cell layer thick and fits tightly onto the heart muscle. The parietal pericardium is much tougher and thicker and has fibers that tether the heart to the rib cage and diaphragm. There is a potential space between the layers, meaning that in normal situations, it has a minimal amount of fluid. However, should inflammation occur, it can fill with fluid. Inflammation of the lining of the heart is called pericarditis (itis=inflammation).

Pericarditis Definition

Possible causes

Pericarditis is inflammation of the lining around the heart (the pericardium) that causes chest pain and accumulation of fluid around the heart (pericardial effusion). There are many causes of pericarditis, including:

Infections

Injury

Radiation treatment

Chronic diseases

SOURCE:
MedTerms

What are the symptoms of pericarditis?

Chest pain is the most common symptom of pericarditis.

Classically, the pain begins in the center of the chest and radiates to the neck or upper back.

The pain is sharp and stabbing, but may also be felt as a dull ache or burning pain.

The intensity may be mild or very severe and it can come on gradually or suddenly.

The pain makes it hurt to take a breath.

Most individuals feel worse when lying flat.

Other symptoms may include fevers and chills, sweats, shortness of breath, and difficulty swallowing.

When pericarditis is due to infection, the symptoms tend to arise quickly. Inflammation due to chronic diseases is more gradual in onset.

What causes pericarditis?

Pericarditis is usually from unknown causes (idiopathic). The cause may often be viral infections. Causes of pericarditis include:
Infections: Inflammatory diseases:
Diseases that can cause generalized inflammation in other places within the body can also cause inflammation of the pericardium. Some examples include:
Metabolic illnesses: Heart disease:

Heart attack can cause direct irritation and inflammation of the pericardial lining.

Dressler's syndrome describes inflammation caused by an immune response to heart tissue damage from heart attack, open heart surgery, or a trauma.

Other causes:

IMAGES
See a detailed medical illustration of the heart plus our entire medical gallery of human anatomy and physiology See Images

How is pericarditis diagnosed?

History and physical examination

The diagnosis of pericarditis begins with the health care professional taking a history about the pain and its character. The health care professional will perform a physical examination and ask the patient about associated symptoms. Past medical history is important, since pericarditis can be a complication of a chronic disease or a side effect of medication.

The most common physical finding that helps confirm the diagnosis of pericarditis is a pericardial friction rub. Inflammation prevents the two layers of pericardium from easily sliding against each other with each heartbeat. The inflammation causes a friction noise that can be heard with a stethoscope when listening to the heart. It is better heard when the patient leans forward, which causes the heart to shift to the front of the chest. The rub may not always be present and may come and go from hour to hour.

Diagnostic testing

The electrocardiogram (EKG or ECG) shows electrical activity of the heart. In pericarditis, there are hallmark changes that are seen and can help make the diagnosis. While an abnormal EKG is helpful in making the diagnosis, in the early stages of inflammation, the EKG may be normal. In most cases of uncomplicated pericarditis, a chest X-ray is usually normal. However, if fluid accumulates in the pericardial sac, the heart can appear larger on the X-ray.

A sound wave test of the heart (an echocardiogram or ultrasound of the heart) is very helpful in detecting and quantifying the fluid in pericarditis. The purpose of the test is to detect an accumulation of fluid in the pericardial sac, called an effusion. Although in many mild cases of acute pericarditis, there is no pericardial fluid seen with echocardiography. A variety of blood tests may be ordered depending upon the clinical situation.

Pericardiocentesis (please see below), a procedure using a needle, is used to draw fluid out of the pericardial sac. It may be done to detect bacterial infection. This procedure can also be used to treat dangerous, severe pericarditis called pericardial tamponade.

What is the treatment for pericarditis?

Most often, pericarditis is caused by a viral infection and the treatment is aimed at decreasing inflammation and controlling pain. Nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen [ Motrin and others], naproxen [ Aleve, Naprosyn, and others]) are commonly used. A short course of narcotic pain medication may be helpful. For other causes of pericarditis, treatment of the underlying cause of pericarditis is essential.

Pericardiocentesis, a procedure where a thin needle is inserted through the chest wall into the pericardial sac, may be considered if a large effusion is present that affects heart function (see cardiac tamponade below).

Pericardotomy (cutting a hole in the pericardial sac) or pericardectomy (removing the sac completely) may be needed for recurrent pericarditis that causes scarring within the pericardial sac and prevents the heart from beating properly.

What are the complications of pericarditis?

Cardiac tamponade

If enough fluid accumulates in the pericardial sac, it can affect heart function and decrease blood pressure. The fluid can accumulate gradually over time or can gather rapidly, depending on the cause. The increased amount of fluid can cause a rise in pressure within the pericardial sac. This causes two potential problems:

The ventricles or lower chambers of the heart responsible for pumping blood to the body have difficulty filling with blood because the fluid in the sac prevents them from filling with blood. That means there is less blood to send to the body with each heartbeat.

The increased pressure within the pericardium may decrease the amount of blood that can return to the heart. The less blood that returns means there is less to pump out with the next heartbeat.

If a disease causes the pericardial effusion to increase in size slowly, symptoms may come on gradually and the heart can adapt. The symptoms may be nonspecific but can include shortness of breath and difficulty with exercise or doing daily activities. But if the fluid accumulates quickly, like bleeding because of trauma, small amounts of fluid can cause significant problems.

Cardiac tamponade is a medical emergency and the patient may be in shock with low blood pressure, difficulty breathing, and congestive heart failure. The classic findings of cardiac tamponade are:

low blood pressure;

distended veins in the neck (jugular vein bulging); and

muffled heart tones using a stethoscope.

Testing requires emergent EKG, portable chest X-ray, and echocardiogram. Some hospitals are not staffed 24 hours a day by a cardiologist or with an echocardiogram and the diagnosis is often made clinically.

Cardiac tamponade is a true medical emergency that requires pericardiocentesis, a procedure where a long needle is inserted through the chest wall into the pericardial sac and the fluid is removed. This relieves the pressure within the sac and temporarily resolves the acute emergency. A plastic tube or catheter may be left in the chest until the underlying illness that caused the tamponade is treated and stabilized.

Constrictive pericarditis

Recurrent inflammation of the pericardial sac can lead to scarring of the space between the two layers of the pericardial sac. The scarring constricts the movement of the heart during each heartbeat and can prevent the heart from expanding to accept blood returning from the body after each heartbeat. This affects heart function and cardiac output because with less blood returning with each beat, there is less that can be pumped out with the next heartbeat.

Bleeding into the pericardium from trauma or from a heart operation is the most common cause of constrictive pericarditis, but tumors, or infections like tuberculosis or fungus, can also be the cause.

The constriction occurs slowly over time and will cause shortness of breath on exertion and decreased ability to exercise. Swelling in the legs and the abdomen may exist because it is difficult for blood to return to the heart, and the back pressure in the veins causes fluid to leak out into the tissues.

Diagnosis is made again by history, physical examination, EKG, echocardiography, and sometimes computerized tomography (CT) of the chest.

If there is significant scarring of the pericardial sac, pericardotomy -- an operation to split open the pericardium to free up the constriction -- may be required to improve function. If the whole pericardium must be stripped away from the heart muscle, the procedure is called a pericardectomy.

QUESTION
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Medically Reviewed on 11/26/2019

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

Complete List

Top Pericarditis Related Articles

Kidney (Renal) Failure

Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis.

Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.

Ultrasound

Ultrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:

TIAs,

stroke,

aneurysm's,

heart valve irregularities,

carotid artery disease,

heart disease,

gallstones,

kidney stones,

liver disease,

diseases of the female reproductive, and

diseases of the male reproductive organs.

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Pericarditis: Effusion, Symptoms, ECG, Causes, Treatments

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Pericarditis is a heart condition in which the pericardium (the sac around your heart) is inflamed. The inflammation may produce a collection of fluid in the pericardial sac called pericardial effusion. Learn the symptoms, causes, diagnosis and treatments for this condition.

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In Pre hospital setting: the management of this condition should be; the admin of aspirin. Also appropriate management should be considering essential referrals for expert opinions so if needed transport to the nearest ER for this to be made optional.

One drug that can be given to help with this condition is Colchicine, and NSAIDs (such as ibuprofen).

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Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction. Its signs and symptoms include chest pain, which may radiate to the arm and jaw and pericardial friction rub (a scratching or creaking sound produced by the layers of the pericardium rubbing over each other) on auscultation of heart sounds. The diagnosis of straightforward pericarditis may be within the scope of practice of the emergency care practitioner. It should be possible for an emergency care practitioner to reach a working diagnosis and to initiate a treatment regimen, which would predominantly consist of providing analgesia to make the patient more comfortable.

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Pericarditis is an inflammation of the two layers of pericardium, the thin, sac-like membrane that surrounds the heart. Its causes are thought to be viral, fungal or bacterial. Pericarditis may also present as a result of a myocardial infarction.

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85-90% of people with pericarditis experience chest pain as a symptom, this is often a sharp, stabbing pain that will present suddenly.

The pain that you will experience will present in the middle or left side of your chest behind the breastbone, the pain can also radiate down into; the neck, jaw or arm similar to the signs and symptoms of a heart attack.

Other signs and symptoms which may be presented are:
Low fever
Weakness and fatigue
Trouble breathing (especially when laying down)
Palpation
Dry cough
Swelling in specific area such as; feet, legs and ankles

Your symptoms may worsen when you lay flat, take deep breaths in or cough or swallow.

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Pericarditis is the inflammation of the pericardium, a thin, two-layered sac that surrounds your heart.

The layers have a small amount of fluid between them to prevent friction when the heart beats. When the layers are inflamed, it can result in chest pain.

The role of the pericardial fluid is to lubricate the heart and the pericardium protect it from infection. The pericardium also helps keep your heart in place inside the chest wall.

Pericarditis is an inflammatory condition, usually acute, coming on suddenly, and lasting a from few days to a few weeks.

The cause of most pericarditis isn't known, but viral infections are thought to be responsible for 80 to 90 percent of cases.

Anything else that causes inflammation, such as cancer, can also cause pericarditis. Certain medications can also be a cause.

Most of the time, pericarditis resolves on its own. However, treatments are available to decrease the duration of the condition and prevent recurrences.

Other inflammatory conditions of the heart are:

Endocarditis. This involves the inflammation of the endocardium, the inner lining of your heart chambers and valves. It's usually caused by a bacterial infection.

Myocarditis. This is the inflammation of the heart muscle, or myocardium. It's usually caused by a viral infection.

Myopericarditis. This is an inflammation of the heart muscle and pericardium.

Acute pericarditis is most common. It may occur on its own or as a symptom of an underlying disease.

Recurring (or relapsing) pericarditis may be intermittent or constant. The first recurrence is usually within 18 to 20 months of the initial attack.

Pericarditis is considered chronic when a relapse occurs as soon as anti-inflammatory treatment is stopped.

Pericardial effusion is a buildup of fluid in the pericardium layers. Almost a third of people with large pericardial effusions develop cardiac tamponade, which is a medical emergency.

Cardiac tamponade is a sudden buildup of fluid in the pericardium layers, which causes your blood pressure to drop and stops your heart from being able to fill. This requires emergency treatment.

Delayed pericarditis or Dressler syndrome is when pericarditis develops in the weeks after heart surgery or a heart attack.

Constrictive pericarditis is when the pericardium gets scarred or sticks to the heart so the heart muscle can't expand. This is rare and can develop in people with chronic pericarditis or after heart surgery.

Effusive-constrictive pericarditis is when both effusion and constriction are present.

Pericarditis can feel like a heart attack, with a sharp or stabbing pain in your chest that comes on suddenly.

The pain can be in the middle or left side of your chest, behind the breastbone. Pain may radiate to your shoulders, neck, arms, or jaw.

Your symptoms may vary, depending on the type of pericarditis you have.

When you have a sharp chest pain, it's best to seek medical help right away.

About 85 to 90 percent of people with pericarditis have chest pain as a symptom. Other symptoms include:

low fever

weakness or fatigue

trouble breathing, especially when lying down

palpitations

dry cough

swelling in your feet, legs, and ankles

Your symptoms may worsen when you:

Sitting up and leaning forward may make you feel better.

If the cause of your pericarditis is bacterial, you may have fever, chills, and an above-normal white cell count. If the cause is viral, you may have flu-like or stomach symptoms.

Most often, the cause of pericarditis isn't known. This is called idiopathic pericarditis.

In general, pericarditis can have infectious or noninfectious causes. Infectious causes include:

viruses

bacteria

fungi and parasites, which are both very rare causes

Noninfectious causes include:

Your doctor will ask about your medical history, what your symptoms are, when your symptoms began, and what seems to make them worse.

They'll give you a physical exam. When your pericardium is inflamed, the amount of fluid may increase between the two layers of tissue in the sac, resulting in an effusion. The doctor will listen with a stethoscope for signs of excess fluid.

They'll also listen for friction rub. This is the noise of your pericardium rubbing against the outer layer of your heart.

Other tests used in diagnosis include:

chest X-ray, which shows the shape of your heart and possible excess fluid

electrocardiogram (ECG or EKG) to check on your heart rhythm and see if the voltage signal is reduced because of excess fluid

echocardiogram, which uses sound waves to show the shape and size of your heart and whether there is fluid collection around the heart

MRI, which gives a detailed view of your pericardium, including whether it is thickened, inflamed, or if there's a fluid collection

CT scan, which gives a detailed picture of your heart and pericardium

right heart catheterization, which gives information about the filling pressure in your heart

blood tests to look for markers of inflammation that suggest pericarditis or any suspected systemic disease

Treatment for pericarditis will depend on its underlying cause, if it's known. If you have a bacterial infection, you may be given antibiotics.

In most cases, according to the American Heart Association, pericarditis is mild and will clear up on its own with simple treatment, such as anti-inflammatory medications and rest.

If you have other medical risks, your doctor may initially treat you in the hospital.

Treatment aims to reduce your pain and inflammation and minimize risk of recurrence. The usual therapy for people without other medical risks includes:

NSAIDs

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for both pain and inflammation. Ibuprofen or aspirin provide relief quickly.

If your pain is severe, your doctor may prescribe a stronger medication.

Colchicine

Colchicine is an inflammation-reducing drug that's effective in minimizing duration of symptoms and preventing pericarditis recurrences.

Corticosteroids

Corticosteroids are effective in reducing pericarditis symptoms.

But studies have shown that early use of corticosteroids may have an increased risk of pericarditis recurrence and should be avoided except in extreme cases that don't respond to traditional treatment.

Surgery

Surgery may be considered in recurrent pericarditis that doesn't respond to other treatment. Removal of the pericardium is called pericardiectomy. This treatment is usually reserved as a last-line therapy.

Drainage of excess fluid may be necessary. This can be performed surgically or by insertion of a catheter. This is called pericardiocentesis or pericardial window.

You may not be able to prevent pericarditis, but you can minimize the risk of pericarditis recurrence. It's important to follow your treatment plan.

Until you fully recover, rest and avoid strenuous physical activity. Discuss with your doctor how long you should limit your activity.

If you see any signs of recurrence, check with your doctor as soon as possible.

Recovery from pericarditis takes time. In some cases, it may take you weeks for symptoms to complete resolve.

Most cases of pericarditis are mild and without complications. But there can be complications with chronic pericarditis, including fluid buildup and constriction of the pericardium.

Treatments for these complications are available, including surgery. Research about medical treatment options is ongoing.

If pericarditis becomes chronic, you may need to continue taking NSAIDs or other drugs.

Seek help right away if you have any type of chest pain, as it can be a sign of something more serious.

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Pericarditis: Symptoms, Treatment, Causes, Diagnosis, and More

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Pericarditis is the inflammation of the pericardium, a thin, two-layered sac that surrounds your heart. The layers have a small amount of fluid between them to prevent friction when the heart beats. When the layers are inflamed, it can result in chest pain.