Pericarditis is swelling and inflammation of the sac around the heart. This can make it hard for the heart to work as it should. It can range from mild to severe and life-threatening.
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The cause of pericarditis is often unknown. Some causes may be:
- Infections from viruses, bacteria, fungi, or parasites
- Heart attack
- Inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus
- Cancer that has spread from a tumor near the heart
- Kidney failure
- Injury or surgery affecting the chest, esophagus, or heart
- Radiation therapy
- Certain medicines used to suppress the immune system
The risk of pericarditis may be higher in people with immune system problems.
A person with pericarditis may have:
- Sharp, stabbing chest pain—it gets worse with breathing in or when lying down
- Problems breathing
- Fever and chills
- Fast heartbeats
- Pain when swallowing
- Weakness and tiredness
The doctor will ask about symptoms and health history. A physical exam will be done. The doctor will listen for abnormal sounds in the heart or lung.
Images of the heart and chest will confirm the diagnosis of pericarditis. They may be taken with:
- Chest x-ray
- ECG—shows the heart's electrical activity
- Echocardiogram—shows how well the heart muscle is working
- MRI scan or CT scan—detailed images of tissue in the chest
Other tests may be needed to find the cause, such as:
- Blood tests
- Pericardiocentesis—test of the fluid around the heart
The goals of treatment are to ease pain and swelling. If a cause is known, it will be treated.
Mild swelling will often pass in a few weeks or month. Care may include:
- NSAID medicine to reduce swelling
- Follow up with the doctor to check on progress
Severe swelling can be an emergency. It may make it hard for the heart to beat. Hospital care may be needed. Treatment may include:
- Removing fluid from the heart sac. The fluid is removed with a needle.
- Surgery to open the sac. This will ease pressure on the heart. This is a rare option.
Other inflammatory diseases raise the risk of pericarditis. It may last longer or tend to come back. A treatment plan will be made to help reduce the risk of more problems.
There are no current guidelines to prevent pericarditis.
- Acute and recurrent pericarditis. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-and-recurrent-pericarditis.
- Andreis, A., Imazio, M., et al. Contemporary diagnosis and treatment of recurrent pericarditis. Expert Rev Cardiovasc Ther, 2019; 17 (11): 817-826.
- What is pericarditis? American Heart Association website. Available at: https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis.
- Michael J. Fucci, DO, FACC
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