Pericarditis

What is pericarditis?

Pericarditis is inflammation of the pericardium, which is a protective fluid-filled sac that surrounds the heart.

When the pericardium becomes inflamed it causes the two layers of thin tissue that make up this sac to swell and rub together causing irritation.

The main types of pericarditis include:

• acute pericarditis - symptoms come on quickly, but only last for a short period of time eg. one to three weeks
• chronic pericarditis - symptoms develop slowly, and persist for an extended period of time eg. more than three months
• recurring pericarditis - recurrence of pericarditis after four or more weeks with or without symptoms

What is the difference between pericarditis and myocarditis?

While pericarditis is inflammation of the pericardium surrounding the heart, myocarditis is inflammation of the heart muscle itself (known as the myocardium).

It is not uncommon for these two conditions to occur together, in which case the condition is called myo-pericarditis.

What are the symptoms of pericarditis?

The most common symptom of pericarditis is chest pain.

For most people this will be a sharp, stabbing pain, but it may also be a dull, aching pain.

The pain may:

• radiate into the left shoulder, neck and arm
• worsen when laying down, coughing, or breathing deeply

Other symptoms include:

• shortness of breath
• sweating and chills
• fever
• feeling faint or dizzy
• fatigue
• heart palpitations
• cough
• swelling of the legs or abdomen

Symptoms of pericarditis may mimic other common conditions such as heart attack, so it is important to seek medical advice immediately.

What causes pericarditis?

Causes of pericarditis can include:

• viral, bacterial, or fungal infection
• heart attack or heart surgery
• injury to the heart or chest
• kidney failure, cancer and other health issues
• autoimmune inflammatory diseases such as rheumatoid arthritis or lupus

The cause of pericarditis may not be able to be identified in all patients.

How is pericarditis diagnosed?

Your doctor may perform the following tests to diagnose pericarditis:

• listening to the heart with a stethoscope to check for a sound known as a 'pericardial friction rub' (often just called a 'rub') – this is the sound made by the two layers of inflamed pericardial tissue rubbing together
• electrocardiogram (ECG) – this is particularly important as pericarditis has a classic pattern that can be identified via ECG
• blood tests
• echocardiogram (heart ultrasound)
• chest x-ray
• CT scan
• MRI scan

How is pericarditis treated?

Treatment for pericarditis will depend on the severity and type of pericarditis.

Treatment options may include:

• non-steroidal anti-inflammatory (NSAIDs) medication
• colchicine (a medicine that reduces inflammation and is also used for gout)
• high-dose aspirin
• steroids (usually prednisolone or prednisone)
• other immune-modulating therapies
• reduced physical activity for a period of time to prevent damage to the heart

How can pericarditis be prevented?

It’s not possible to prevent pericarditis, though you can take steps to reduce your risk of developing the underlying conditions that can lead to pericarditis, such as viral infections and heart attack.

Those with acute pericarditis should seek appropriate treatment to reduce the risk of recurring pericarditis, chronic pericarditis or complications associated with pericarditis.