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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Pericarditis

What is it?

Pericarditis is inflammation of the pericardium, the membrane that surrounds and protects the heart. It occurs in two forms: acute (sudden and short-lived) and chronic (persistent over long periods). The most common type of acute pericarditis, caused by a viral infection, generally resolves spontaneously with no permanent damage, even without treatment. Acute pericarditis due to bacterial infection, however, may cause fluid to accumulate in the space between the pericardium and the heart (pericardial effusion) and interfere with the heart's ability to function properly. This may result in severe symptoms and may even be fatal unless fluid is promptly removed from the pericardial sac. In chronic pericarditis, ongoing inflammation scars and thickens the pericardium (constrictive pericarditis) so that it constricts the heart and hinders the heart's ability to fill with blood returning from the great veins. Constrictive pericarditis nearly always leads to progressive heart failure; surgical intervention is often curative.

What Causes It?

  • Acute pericarditis may result from a number of underlying disorders, including: viral, bacterial, or fungal infection; heart attack; rheumatic fever; systemic lupus erythematosus; rheumatoid arthritis; hypothyroidism;metastatic cancer; and kidney failure.
  • Acute pericarditis may occur following a chest injury or open heart surgery.
  • Chronic pericarditis may develop from recurrent acute cases.
  • Chronic cases may result from a chronic infection such as tuberculosis.
  • In some cases the cause is unknown.

Prevention

  • There are no specific measures to prevent this condition.

Diagnosis

  • Medical history and physical examination, including listening for abnormal heart sounds with a stethoscope.
  • Blood and urine tests.
  • Chest x-rays.
  • Electrocardiogram (ECG), which measures electrical activity in the heart.
  • Echocardiography (ultrasound imaging of the heart).
  • Culture of pericardial fluid taken through a needle to identify infectious organisms.

How to Treat It

  • The underlying cause is treated if possible. For example, antibiotics are given for bacterial infections.
  • Analgesics (including aspirin and ibuprofen) are used to reduce pain and inflammation.
  • Diuretics may be used to reduce fluid retention.
  • Bed rest and restricted activity may be advised.
  • Surgical drainage of fluid with a needle (pericardiocentesis) may be required for severe pericardial effusion.
  • Partial or total surgical removal of the pericardium (pericardectomy), the treatment of choice for chronic pericarditis, often yields excellent results.

When to Call a Doctor

  • If you experience any symptom of pericarditis, get to a doctor as soon as possible.