Causes and Risks:
Pericarditis can be caused by bacterial, fungal, or viral infections such as polio, influenza, rubella, rheumatic fever and tuberculosis. The most common identifiable causes in children are adenovirus and cocksackie viruses.
It may be a result of injury or trauma to the chest, esophagus, or heart. Pericarditis may be caused by systemic diseases such as cancer, kidney failure, leukemia, HIV infections, AIDS or AIDS related disorders, autoimmune disorders, heart attack, myocarditis, and treatments such as radiation therapy to the chest and use of medications that suppress the immune system.
Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may accumulate in the pericardial sac.
Classifications of pericarditis include bacterial pericarditis (also called purulent or infectious pericarditis), constrictive pericarditis, and post-MI pericarditis. Restrictive cardiomyopathy is a disorder that can result from pericarditis when inflammation of the pericardial sac results in fibrosis and scarring of the pericardium. This can result in restriction of the normal cardiac function. Pericarditis can often affect men ages 20 to 50, usually following respiratory infections. It can also occur after a myocardial infarction.
Prevention: Many cases may not be preventable. Treat respiratory infections and other disorders promptly.
Symptoms:
- Chest pains
- Usually relieved with sitting
- Pleuritis type: described as sharp, stabbing
- May radiate to the neck, shoulder, back, or abdomen
- Increases with deep breathing
- Breathing difficulty, lying down (the preferred position is upright, standing, or sitting)
- Splinting of ribs (bending over or holding the chest) with breathing
- Difficulty breathing
- Dry cough
- Swelling of the abdomen (occasionally)
- Swelling, overall (occasionally)
- Ankle, feet, and leg swelling (occasionally)
- Anxiety
- Fatigue
- Fever
- Chills
- Sweating
Signs and Tests:
When listening to the heart with a stethoscope (auscultation), the health care provider can hear a pericardial rubbing sound and heart sounds may be faint or distant. There may be other signs of fluid in the pericardium (pericardial effusion). If the disorder is severe, there may be crackles in the lungs, decreased breath sounds, or other signs of fluid in the space around the lungs (pleural effusion).
Fluid around the heart may show on:
These tests may show scarring and contracture of the pericardium (constrictive pericarditis), or they may show enlargement of the heart from fluid collection in the pericardium.
An ECG is abnormal in 90% of patients with approximately 50% being characteristic ECG changes for acute pericarditis. The ECG changes generally evolve in stages during the disease process.
Cardiac enzymes (LDH and CPK tests) may be used to rule out acute MI (heart attack) as the cause of chest pain. However, mild elevations of cardiac enzymes can also occur in pericarditis. (Heart attack is rare in children).
Other tests may include:
Treatment:
The goal of treatment is improvement of heart function. The cause must be identified and treated. This may include anti-inflammatory medications or other treatments.
Medications include analgesics to relieve pain and diuretics to remove excess fluid. Aspirin, nonsteroidal anti-inflammatory medications (NSAIDS), or corticosteroids may be prescribed to relieve inflammation of the pericardium.
Pericardiocentesis (removal of excess fluid from the pericardial sac) may be recommended if enough fluid collects in the pericardial sac to compromise the heart function. Surgical pericardiectomy (cutting or removal of part of the pericardium) may be advised if the disorder is chronic, recurrent or results in hemodynamically significant cardiac tamponade.
Prognosis: Pericarditis can range from mild cases that resolve on their own, to life threatening, if complicated by significant fluid buildup around the heart and hemodynamic compromise (poor cardiac output). The outcome is good if the disorder is treated promptly. Most people recover in 2 weeks to 3 months.
Complications:
Call your health care provider if symptoms indicate pericarditis may be present. The disorder can be life threatening if untreated.
